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COPYRIGHT DEPOSm 



THE PHARMACOPEIA 

AND 

THE PHYSICIAN 



A Series of Articles which Originally Appeared in the Journal 
OF THE American Medical Association, Discussing the Chief 
Substances in the United States Pharmacopeia, Class- 
ifying Them According to Their Uses and De- 
scribing Their Methods of Combination and 
How They May Take the Place of Many 
Proprietary Preparations for 
Which Extravagant Claims 
Have Been Made. 



By 
ROBERT A. HATCHER, Ph.G., M.D. 

Assistant Professor of Pharmacology, Cornell Universitv Medical SchooF, 
New York 

AND 

MARTIN I. WILBERT, Ph.M., 
Apothecary to the German Hospital, 
Philadelphia 



[Second, Revised, Edition.] 



<;iiiCA<;u : 

AMKKICAX MKUICAL ASSOCI.VJIi IN J'Ul 

1908 



LIBRARY of CONcSRESS! 


Two Copies 


Hecri.._.^ 


MAR 12 


1908 






1 COHV 


9 / 

a. 



^ 



<b\' 



:1^ 



Authority to use foi: co.m.uknt the I'harmacoi'eia m- 
THE United States of AiiEiticA, Eighth Decennial IIe- 

VISIOX, IN THIS volume, HAS BEEN GRANTED BY THE BOARD 

OF Trustees of the United States Pharmacopeial Con- 
vention, WHICH Board of Trustees is in no way respon- 
sible for the accuracy of any translations of the 
official weights and measures, or Fdi! any statements 

AS TO strength (iF iiFFICIAI. I'UKI'A HAT K i.N S. 



Copyright, 1908, by 
American Medical Association. 



CONTENTS 



PAGE. 

Introduction & 

Use of Extraphavmacopeial Substance^ and the Na- 
tional Formulary 14 

CJenoral Disinfectants, ; . . 28 

Sunlipht and Heat 31 

Chemical Disinfectants 32 

Clinical Thermometers and Syringes 43 

I^cal Disinfectants and Antiseptics 47 

!Mereurials 59 

Antisepsis of the Mucous ]\Ienibranes 01 

Internal Antiseptics 08 

General Tonics 90 

Hematinics 91 

Iron 91 

Arsenic 107 

Phosphorus 114 

Cod Liver Oil 122 

Alteratives 125 

]\rercurv and the ^Mercurials 127 

Thyroid Gland 141 

Stomachics 143 

Aromatics 147 

Astrinffent Bitters 148 

Carminatives 153 

Difrestants and Dietetics 1G2 

Astringents 179 

Irritants. Emollients and Demulcents 201 

Ruljefacients 202 

\'()hitile Oils 20G 

Vesicants 217 

Pustulants 223 

Caustics 224 

Kniollients 220 

l.oial Anesthetics and Anodynes 234 

(ieneral Aiicstlictics 252 



CONTENTS. 

PAGE. 

Expectorants 269 

Sedative Expectorants 271 

Stimulating Expectorants 279 

Anodynes 287 

Demulcent Expectorants 289 

Analgesics and Soporifics , 291 

Morphin and Opium Preparations 293 

The Atropin Group 306 

The Acetanilid Group 309 

Tlie Hydrated Chloral Group 321 

The Bromid Group 325 

Circulatory Stimulants 330 

Physiologic Salt Solution 335 

The Digitalis Group 337 

Ammonium Preparations 358 

Alcohol and Derivatives 360 

Circulatory Depressants 365 

Diuretics and Diaphoretics 377 



Irritants 
Volatile Oils 



384 
384 



Saline Diuretics 386 

Diaphoretics 388 

Cathartics 393 

The Anthracene Derivatives 394 

The Anhydrid Group 403 

Purgative Oils 407 

Laxative Sweet Substances 409 

Saline Cathartics 410 

Mercurials 418 

Treatment of Constipation 424 

Emmenagogues and Antispasmodics 426 

Official Antispasmodics 432 

Parasiticides and Antigonorrheics 436 

Anthelmintics 439 

Teniafuges 445 

Antigonorrheics 451 

Vehicles "^f 

Medicated Waters 459 

Suggestive Coloring 468 

Index : 469 



PREFACE TO THE SECOND EDITION 



'J'lie nucleus of the material that now comprises 
the chapters of this book Avas originall}' compiled 
to assist in the introduction of the Pharmacopeia 
of the United States, its scope and contents and 
tlic possibilities and uses of official remedies, to 
the physicians of this country. ^\niile it is true 
that the Pharmacopeia itself may be considered 
as being, in a certain sense, a reference book on 
pharmacology, the information that it contains is 
not of a nature to indicate the various actions of 
the several drugs on the animal organism or to 
suggest the therapeutic uses of official remedies. 

Sc]imiedel)erg asserted, many years ago, that 
the proper function of pharmacology is to indicate 
the way, or to point out the material that is use- 
ful, to the clinician and not to give detailed direc- 
tions for tlie therapeutic uses of the remedies them- 
selves. 

In the following chapters an earnest effort has 
been made to heed these limitations, and the com- 
pilers have endeavored to discuss, at times at some 
length, the more important and more reliable of- 
ficial remedies from a purely pharmacologic point 
of view, for it is now generally admitted that the 
pharmacologic action is the only reliable key to 
the therapeutic use of a drug. To the keen ob- 
server of matters medical it must be evident that 
tlio physician who has secured a firm grasp on the 



4 I'RKFACE TO SECOXD EDITION. 

])ossil)il!ties and the limitations of medicinal sub- 
stances, as indicated by their pharmacodynamic 
action, will not be misled either by the wily tales 
of the detail man or the all too frequently hap- 
hazard clinical observations made by overzealoiis 
fellow practitioners. A physician who has mas- 
tei-ed the fundamentals of pharmacology will thor- 
oughly appreciate that there can be no virtue in 
secrecy so far as drugs and medicinal substances 
are concerned, and will readily recognize the self- 
evident fact that all of the effects produced by 
esoteric combinations of well-known medicaments 
can, and must, be produced equally well by the 
use of the same medicaments under their proper 
designations. 

With the gradual increase of our knowledge con- 
cerning the pharmacology of drugs there must be 
a corresponding decrease in the need, or the sup- 
posed need, for the empiric use of complex mix- 
tures of either known or unknown composition, 
and the future medical practitioner will be in a 
position to evolve a comprehensive system of drug 
therapeutics from an intimate knowledge of the 
pharmacology of but a limited number of drugs 
and will, therefore, be free to ignore the use of all 
nostrums or ready-made prescriptions. 

The first reprint of the original articles, in book 
form, was in the nature of an experiment, and it 
is particularly gratifying, therefore, that a second 
edition is needed at this time. The rapidity with 
which the first edition was sold evidences a healthy 
spirit of inquiry on the part of medical practi- 
tioners, and is no doubt indicative of an honest 
attempt on the part of many older men in the 



PREFACE TO SECOXD EDITIOX. 5 

medical profession to break away entirely from the 
use of secret or proprietary nostrums and confine 
tliemselves more and more to open formulas and 
official preparations. 

The compilers of the material herewith pre- 
sented are, however, desirous of doing even more 
than this. Tliey are anxious to awaken a more 
Avidespread recognition of the fundamental prin- 
ciples of a rational materia medica based on de- 
monstrable action of medical substances on the ani- 
mal organism. They feel that with a proper ap- 
preciation of the possibilities of the science of 
pharmacology the practice of medicine can rid it- 
self of the over confidence of the more credulous in 
complex specifics, and also rid itself of the last 
vestiges of therapeutic nihilism, real or imaginary, 
that is now evidenced by the practices of some of 
the more skeptical. In place of the really unsat- 
isfactory conditions of to-day we may look for- 
ward then to a healthy spirit of optimism based on 
tlie demonstral)le action of substances of definite 
composition. 

Tlie compilers wish to lay particular stress upon 
the oljligation which every man owes to his profes- 
sion — the duty to transmit, unimpaired, the knowl- 
edge of the action, and comparative value of thera- 
peutic agents, which he lias received as the result 
of past experiences, with the added weight of his 
own experience based on intelligent observation. 
'I'bis is wliolly impossible with those who take up 
.•mil lollou I he cry put into their mouths by wily 
iiiakcis of no.slriims — "T will use anything that 
Iif'lps my patients." Such an ()l)viously correct 
iH-occdiirc is made tbc cvciisc toi' u^\n<s aiivtbin<r 



6 PREFACE TO SECOND EDITION . 

that is said to help the patient, which is very com- 
monly the exact opposite of what the original say- 
ing proclaims. 

It is extremely difficult to know what will help 
our patients at times, but it is never difficult to 
find scores of remedies which are said to help any 
given condition. When carefully analyzed this 
frequently-heard cry is found to be an obviously 
shallow expression, as it presupposes infinite thera- 
peutic and pharmacologic knowledge. If it is fol- 
lowed with nostrums as a basis we must soon come 
to the point of utter confusion so far as ex- 
perience is concerned, for the nostrum exists but a 
day, until another, more blatantly advertised, re- 
places it. 

One really great evil which pertains to the nos- 
trum traffic, and one which is not usually consid- 
ered, is the deliberate attempt to misrepresent and 
belittle the value of thoroughly well established 
official remedies. If a manufacturer attacks the 
products of a rival a counter attack will let in too 
much light for the good of either, hence there is 
a mutual regard, or at least tolerance, established 
between nostrum makers, but it appears that no 
one is particularly interested, at least financially, 
in the official materia medica, and attacks may be 
made on official articles with impunity. With the 
individual practitioner this species of attack fre- 
• [uently leads him to overlook, or to ignore entirely, 
his heritage of the knowledge of the therapeutics 
of official articles, sometimes the result of centuries 
of experience, and to lend an all too willing ear to 
the claims of the nostrum maker, only to find that 
he has been misled and that, through him, his pa- 



PREFACE TO SECOND EDITION. 7 

tients have been deprived of the advantages of past 
experiences to which they were rightfiill}^ entitled. 
The following simple rules of prescribing have 
been formulated by Torald Sollmann and are well 
worth careful consideration: 

1. Do not use any new substitute (except in the 
way of scientific experimentation) unless it pos- 
sesses distinct advantages over the older remedies. 

2. Do not use a ready-made mixture in condi- 
tions which require individual consideration. 

3. Do not prefer monopolistic proprietary reme- 
dies to official drus's. 



THE PHARMACOPEIA AND THE 
PHYSICIAN. 



INTKODL'CTIOX. 

The Pharmacopeia of the United States of 
America has been the generally accepted authority 
and the j)rofessed guide of American medical men, 
in matters therapeutic and pharmaceutic, for over 
eighty-five years. Since the publication of the 
first edition, in 1820, the book has undergone eight 
decennial revisions and to-day it is universally 
conceded to be the peer of authoritative books of its 
kind, for its scientific accuracy as well as for the 
general excellence of the descriptions and direc- 
tions that it contains. 

This recognized superiority of the Pharmacopeia 
of the United States of America, in its own par- 
ticular field, and its generally accepted authority, 
as a guide, in all matters relating to the strength 
and purity of the medicinal articles enumerated 
in its pages, is all the more remarkable in that 
previous to the enactment of the Food and Drugs 
Act, June 30, 190(5. it had never been granted a 
general recognition by statutory laws. 

'I'his lack of legal recognition lias un(lou1)tedly 
l)eea a disadvantage to tlio book in so far that, in 
the past two decades at least, the contents, and 
oven the vcrv existence, of ■^udi an antlioritativc 



10 PHARMACOPEIA AND PHYSICIAN. 

l)ook have been largely lost sight of by American 
physicians, and official remedies have been eclipsed 
to a very marked degree, or overshadowed by the 
innumerable patented and proprietary remedies 
that are constantly brought to the attention of 
medical men in the advertising material with which 
their offices are regularly deluged. 

With a view of bringing the Pharmacopeia itself, 
its scope and its contents, more prominently before 
the medical profession, it is proposed to present, in 
the following chapters, a collection of facts and 
suggestions bearing on the number and variety of 
therapeutic indications that may be fully met with 
official drugs and preparations. 

It is also proposed to call attention to the un- 
reasonable claims and the extraordinary statements 
that are frequently made in connection with some 
of the arbitrary combinations of drugs that are 
offered as proprietary remedies or "patent" medi- 
cines, and to compare the probable limitations of 
these self-styled panaceas with the possible applica- 
tion and the varied uses of the more simple, and 
therefore more generally reliable, official remedies, 
the composition as w^ell as the purity of which can 
be readily determined by well-know^n and easily 
applied methods. 

It must be admitted that even the most recent, 
the eighth decennial, revision of the Pharmacopeia 
is not free from errors of commission and omis- 
sion, but many of the shortcomings that are usual- 
ly attributed to the book are really due to the gen- 
oral lack of interest that has been displayed by 



IXTRODUCriOX. 11 

physicians; and these shortcomings will be cor- 
rected in future revisions, if members of the medi- 
cal profession will only make their needs and 
wishes known at the proper time and place. 

It has been repeatedly asserted that the Pharma- 
copeia of the United States is designed primarily 
for pharmacists and for the manufacturers of 
phannaceutical galenicals, and that it contains lit- 
tle or nothing of direct interest to the physician. 
One of the prime objects of the following chapters 
is to demonstrate that this assertion embodies only 
a half truth and that the present edition of our 
national Pharmacopeia really contains much that 
should interest every physician. 

In this connection it should also be remembered 
that the technical descriptions and tests, for which 
the average physician may think he has little or no 
use, are in reality essential to secure for him and 
his patients, remedies that are not only reliable, 
but which are also uniformly active. 

The leaders in American medicine have con- 
tributed so little to the evolution and advancement 
of the Pharmacopeia of the United States of 
America during recent decades, that it will be 
interesting, if not surprising, to many, to bo re- 
minded of the fact that the inception and inaug- 
uration of the Pharmacopeia are to be accredited 
to the leading minds in the medical profession of 
tliis country about eighty years ago. 

Lyman Spaulding suggested the fii'st practicable 
plan for securing a national I'hai'iiiacopeia at a 



]I J'NAiniACOl'JJfA AM) I'llYSfCfAN. 

nu'cting of the Xew York County ^ledical Society 
in January, ISIT, the plan was discussed a month 
later at the annual meeting of the Medical So- 
ciety of the State of New York, and a commit- 
tee wag appointed to consider the necessary details 
and to report at the next annual meeting. The 
report of this committee heing in favor of the 
proposed plan, the society appointed delegates in 
1818 to meet in district convention, for the pur- 
pose of forming a pharmacopeia. 

The first General Medical Convention met in the 
Capitol in Washington on Jan. 1. 1820. and the 
first National Pharmacopeia of the United States 
was published in December of the same year. 

An interesting account of the several revisions 
of the Pharmacopeia of the United States may be 
found in the introductory pages of the present, 
eighth decennial, revision. 

'J'he first and practically all of the succeeding 
editions of the Pharmacopeia, up to and including 
the sixth decennial revision, consisted largely of a 
simple enumeration of drugs, with detailed direc- 
tion.? for making the several pharmaceutical prepa- 
rations. A notable exception to this is to be found 
in the Pharmacopeia published by the convention 
which met in the city of New Y^ork in January, 
is:^o. 

The members of this convention, all of them 
physicians, introduced several really novel features 
into this first revision that are only now, three- 
quarters of a century after the puV)lication of the 



IXTRODUCTIOy. U 

book^ being revived and discussed. In addition to 
having short descriptions of the ph3'sical proper- 
ties of drugs, both whole and powdered, this Phar- 
macopeia also included doses, and, what is even 
more, also included short, suggestive remarks on 
the "Medicinal Operations" or therapeutic prop- 
erties of the several drugs that were included in the 
text. 

This edition of the Pharmacopeia was super- 
seded, however, hj the revision published under 
the direction of the convention which met in 
Washington in the same year, and which retained 
all of the features of the first edition. 

Many factors have contributed to the loss of 
interest in the Pharmacopeia by medical men; 
among the more influential of these factors has 
been tlie general mistake of confusing the identity 
of the Pliarmacopeia with that of the several Dis- 
pensatories which have been published, and, lat- 
terly at least, the apparent superfluity of any au- 
thority by the claimed superiority of new or pro- 
prietary remedies over tlie drugs and preparations 
of tlie Pliarmacopeia. 

With the advent of the new century, there ap- 
])cars to iiave been a re-awakening on tlic ])ait ol' 



the members ol 


llic ini' 


die, 


al jjrofession, and 


tlio 


interest that ha 


S br..ii 1,1 


an 


iffsted in the woi' 


k of 


Hm' ('oiincil (111 


1 'liai'iiuK 


■\ 


and Chcniislrv ol 


■ til.' 


AiiuTican .Medi 


cal Assn. 


cial 


lion, the articles 


that 


have appeared ii 


11 lay jdii 


ma 


Is on (lie al)use of 


n OS- 


trums by the Ini 


tv and. 1; 


:|S| 


but b\- no means 1 


cast, 



14 PHARMACOPEIA AND PHYSICIAN. 

the enactment of the Federal Food and Drugs Act, 
have all contributed to a renewed interest in true 
and tried remedies — an interest the authors of the 
following chapters have endeavored to enlarge 
upon and to foster. 

THE USE OF EXTRAPHARMACOPEIAL SUBSTANCES 
AND THE NATIONAL FORMULARY. 

A review of the application and the uses of 
pharmacopeial articles should be supplemented by 
a discussion of permissible extrapharmacopeial 
substances, and at least a passing reference to that 
most legitimate of all sources for extrapharmaco- 
peial preparations— the National Formulary. 

To appreciate more thoroughly the need for au- 
thoritative works of reference on extrapharmaco- 
peial preparations we must remember that the 
remedies which have been properly included in the 
National Pharmacopeia constitute but a very lim- 
ited portion of the possible resources of medical 
men of the present day, and are practically con- 
fined to those well-known drugs and preparations 
that are generally used in all parts of the country, 
and may, therefore, be considered as being thor- 
oughly well established. 

Despite the fact that a medical practitioner who 
is thoroughly well acquainted with the established, 
or official, materia medica is in a position to meet 
nearly all physiologic as well as therapeutic indi- 
cations, so far as known, there is no gainsaying the 
fact that there can be no progress without experi- 
mentation, and experimentation in the field of 



INTRODUCTION. 15 

materia niedica implies the use of new remedies 
in comparatively well understood pathologic con- 
ditions, or the use of established or otherwise well 
understood remedies in conditions that are less 
well understood. 

With the gradual increase of our knowledge of 
the phj'siologic action and the limitations of medic- 
inal substances there is a correspondingly decreas- 
ing need for the empiric use of, or the haphazard 
experimentation with, drugs and other therapeutic- 
ally active substances. On the other hand, it must 
also be remembered that physiologic indications, 
as we understand or interpret them at the present 
time, do not fully represent the therapeutic uses 
and the limitations of medicinal substances in the 
diseased human organism. 

Bearing in mind, then, the imperfect state of 
our knowledge concerning the normal functions of 
the several organs of the human body, the possible 
irregularities or diseases and the treatment of these 
irregularities with the more or less imperfect ma- 
terials at our command, and the demands on the 
general practitioner in the daily routine, no reason- 
able individual can possibly object to the use of 
safe and well-understood substances that have been 
demonstrated to possess medicinal virtues, thougli 
they have not been admitted to the roll of more 
thoroughly established articles represented by 
the Pharmacopeia. Here, however, differences of 
opinion will arise as to what constitutes a safe and 
well-understood medicinal substance. Since it is 



](i J'JlAh'MACOPEIA ASD I'HYHICIAN. 

impossible for a mGdicinally active substance to be 
potent only for good and to be innocuous as far as 
deleterious results are concerned, we must modify 
the first part of our requirements and limit it to 
articles, the action and uses of which have been 
established. 

While this requirement would undoubtedly con- 
stitute a reasonable and rational safeguard, it will 
be difficult to limit ourselves to it too strictly. The 
reasons for this will l^ecome more evident when 
we remember that such a comparatively simple 
drug as squill, which has been in continuous use 
for hundreds of years, even now is not well under- 
stood, either chemically or physiologically, and that 
digitalis, a drug that has been studied by the lead- 
ing men in the medical profession almost continu- 
ously for half a century, still presents problems^ 
both to the clinician and the pharmacologist. 

When we realize how little positive knowledge 
we possess of the action, uses and limitations of 
drugs and medicinal preparations that have been 
in continued use for a long jDeriod of time, we 
begin to suspect that many of the positive claims 
that are now being made in connection with new 
drugs and medicinal preparations that have been 
after more careful observations, be found to be far 
from correct. 

The secondary or so-called untoward effects of 
many drugs and preparations are so insidious that 
much harm may be done before it becomes known 
that such untoward effects should be looked for. 



INTRODUCTION'. 17 

As an illustration of the harm that may result 
from the indiscriminate use of even the compara- 
tively few new remedies that appear to have estab- 
lished themselves as permanent additions to our 
materia medica, attention is directed to the harm 
that has been done, both directly and indirectly, by 
acetanilid. 

Por over twenty years acetanilid was freely 
used, either in substance or in the form of various 
mixtures that are even now being marketed as pro- 
prietary nostrums. All of these preparations were 
presumed to be potent factors for good and innocu- 
ous so far as any deleterious results were con- 
cerned. 

Despite the fact that many physicians suspected 
that acetanilid was directly responsible for a long 
train of little-understood symptoms, that occur as 
complications secondary to its excessive or contin- 
ued use, it is fair to presume that but few were 
prepared to assert that acetanilid was directly to 
Ijlame for so many really serious complications, 
and even deaths, as have been reported during the 
past few years. 

Of the other new remedies that are widely used, 
largely because manufacturers have asserted that 
they are free from possible injurious effects, we 
may refer to the widely used coal-tar hypnotics. 
Drugs of tliis kind are freely used by lay persons, 
of all degrees of intelligence, in the mistaken belief 
that they are safe and harmless. It is known, 
howf'vpr. tliat all liviJiiotifs fondiico in the eon- 



18 PHARMACOPEIA AND PHYSICIAN. 

tinned use of sedative drugs and many are the 
direct cause of physical, mental and moral de- 
generacy. In addition to the possible harm that 
may result from the continued use of drugs of this 
type, it has been repeatedly shown that the coal-tar 
hypnotics, despite their reputed harmlessness, have 
been the direct as well as the indirect cause, of 
death in many instances. 

One more illustration of our overzealousness to 
believe the assertions of manufacturers, to our 
own discredit: A few years ago diacetylmorphin, 
better known by the proprietary name heroin, was 
being exploited as a perfectly safe and reliable sub- 
stitute for morphin. Heroin was reputed to pos- 
sess all of the good properties of morphin without 
any of its faults, and it was even heralded as a 
positive cure for the morphin habit. According to 
more recent reports, however, heroin induces a 
habit as persistent as that caused by morphin. 

The experience that we have obtained from these 
now better understood, and admittedly valuable, 
remedies should be sufficient to make us more 
cautious in the use of new drugs and chemicals 
that are exploited by those whose only interest is 
commercial. The most evident need in connection 
with the introduction of new drugs and chemicals 
is more information bearing on their untoward 
results and shortcomings, so that unnecessary repe- 
tition of disappointing and at times harmful ex- 
periences may be avoided. How imperative is the 
need for greater publicity in connection with newer 



INTRODUCTION. 19 

remedies is well ilhistrated by the volumes that 
have been published about them during the past 
two decades. If we examine one of the volumes 
published ten years ago we find hundreds of highly 
recommended substances that are now out of use, 
despite the fact that no derogatory report can be 
found in the pages of current medical journals. 
It is evident that some vital reason exists for the 
disappearance of these substances, but the present 
method of eliminating such new remedies is objec- 
tionable because it is slow and harmful to our pa- 
tients. 

The publication of the Handbook on ISTew and 
Non-official Eemedies by the American Medical 
Association, through its Council on Pharmacy and 
Chemistr}^, will no doubt contribute materially to 
bring about a better understanding and a more 
rapid elimination of the numerous remedies of un- 
certain value and composition that are now being 
offered. In this connection it is fair to suppose 
that manufacturers who will be given the advan- 
tage of added publicity, for the desirable properties 
of their several preparations, will not oppose free 
and impartial discussion of the shortcomings and 
the limitations of the same preparations. 

Drugs and chemicals of original and meritorious 
character constitute but one of several classes of 
extrapharmacopeial articles that merit careful con- 
sideration. A much larger class, and one whose 
use has been accompanied by even greater abuse?. 
consists of mixtures of more or less well-known 



20 PHARMACOPEIA AXD PHYSICIAN. 

substances whose prej^aration requires only ordi- 
nary pharmaceutical skill and which may lie pre- 
pared quite as satisfactorily l^y the retail pharma- 
cists as by the large manufacturer. The allegations 
that are usually made for mixtures of this kind, 
when exj)loited as proprietary products, are fre- 
((uently misleading, due to the misstatements that 
are made by their manufacturers. 

Another cause for the present situation is the 
assumption by many manufacturers that the sim- 
ple admixture of two or more well-known sub- 
stances constitutes a discover}', and that the mak- 
ing of such a "discovery," or perhaps only the 
rediscovery of such a discovery, should entitle the 
individual making it to absolute control of the par- 
ticular combination, and should further permit 
liim to exact such profits as he sees fit. 

Quite apart from the alisurdity of the claim for 
proprietorship in each mixture is the assumption 
that because such a mixture is made by one certain 
individual or firm it must be invested with cer- 
tain new or extraordinary properties and will, 
therefore, be superior to the same mixture when 
compounded by some other presumably less skillful 
persons. How far-reaching the further unre- 
stricted progress of this species of proprietorship 
might become is indicated by the fact that at the 
present time the available proprietary mixtures 
number over 30,000 distinct preparations, and that 
the articles that are official in the Pharmacopeia of 
the United States alone would offer further possi- 



INTRODUCTION. 21 

bilities of untold thousands of similar "original" 
mixtures. 

While it is reasonable to suppose that one manu- 
facturer may possiljl}- acquire a certain amount 
of skill in the combination of well-known ingre- 
dients, or may even be said to exercise greater 
care in the selection of the constituting materials, 
these assertions and claims are foreign to the ques- 
tion of proprietorship and may be conceded when 
such facts are actually demonstrated. 

Among the factors that have contributed to a 
more reasonable view of proprietorship in medic- 
inal compounds are the I^ational Formulary and 
other books of its type. It is more particularly 
due to the general recognition that has been ac- 
corded the Xational Formulary, as an authoritative 
standard, that we are now able to differentiate 
between the reasonable announcements that are 
made by reputable manufacturers and the bold 
claims of absolute proprietorship, based on pre- 
tended priority of discovery, made by manufac- 
turers of questionable nostrums. 

That the use of well-established formulas, apart 
from those contained in the Pharmacopeia, is not 
a recent one is well illustrated l)y the natural se- 
quence and the evolution of \\('ll-l<iio\vi) formu- 
laries in this country. 

The earliest of these, "Formulae Seloctaj, or a 
Collection of Prescriptions of Eminent Physi- 
cians," was published by K. Donaldson, New York, 
in 1H18, two years before tlie first edition of the 



■21 PHARMACOPEIA AND PHY8WIAN. 

Pliarmacopeia of the United States was published 
in Boston. 

From the preface of this early formulary it ap- 
pears that its publisher fully appreciated the limi- 
tations and the needs of popular formulas and the 
contents of the book show that not a few of the 
problems that confronted the medical practitioners 
of that early date are still with us, though changed 
in character. 

This, the earliest of the known American For- 
mularies, was succeeded by a number of more or 
less similar publications that achieved consider- 
aljle repute and popularity. 

Among the more widely known of these early 
formularies it will suffice to enumerate Ellis' Medi- 
cal Formulary, Beasley's Prescriptions, and Grif- 
fiths' Universal Formulary. 

More than fifty years ago the American Phar- 
maceutical Association set for itself the task of 
compiling and promulgating a generally acceptable 
book of formulas. The first report of a commit- 
tee on unofficial formulas was published in 1857, 
and the idea was periodically revived, from time to 
time, with but indifferent results. 

After the publication of the Pharmacopeia of 
1880 another concerted attempt was made by the 
Araerican Pharmaceutical Association to compile 
an unofficial formulary. Under the able leadership 
of the late Dr. Charles Eice, of New York, as 
chairman, a committee presented "a ijreliminary 
draft of a national formulary" in 1886 and issued 



IXTRODUGTIO^'. 23 

the completed book in 1888. The second edition, 
under the editorship of C. Lewis Diehl, the pres- 
ent chairman of the Committee on National For- 
mulary of the American Pharmaceutical Associa- 
tion, was published in 1896, and the third (1906) 
edition, or the second revision, has been accepted, 
with the Pharmacopeia, as a legal standard under 
the Food and Drugs Act. 

The formulas that are contained in the 241 
pages of this last edition may be divided into 
groups consisting of : 

1. Formulas from former edition of the United 
States Pharmacopeia. These have been gathered 
together in the form of an appendix to the Na- 
tional Formulary and are thus readily available 
for reference. 

2. Formulas oflQcial in foreign pharmacopeias 
which have been popularized to some extent in this 
country through medical literature, but not suffi- 
ciently used to warrant their being included in 
our national Pharmacopeia. 

The many preparations of this type include 
well-known articles as Caffein Sodio-Salicylate, 
Ferrated Extract of Apples, Pectoral Species, 
Laxative Species, Spirit of Formic Acid and 
Ethereal Tincture of Ferric Chlorid, whicli are 
official in the German pharmacopeia. 

3. Formulas introduced by prominent medical 
men or teachers that are either of comparatively 
recent origin or of restricted use. 

This class of formulas is perliaps best illustrated 



24 PJIAJx'MACOPlUA A.MJ I'llYSlCIAN. 

by the derinatologic pastes recommended by Lassar 
and Unna, for which a number of type formulas 
are included. Among others that come under this 
heading are Dobell's Solution, Loomis' Diarrliea 
Mixture and Squibb's Ehubarb Mixture. 

4. Formulas representing present-day survivals 
of the old-time "patent medicines." 

This class is represented by Turlington's Bal- 
sam, Dalby's Carminative, Bateman's Pectoral 
Drops, Godfrey's Cordial and others. 

5. Formulas that closely resemble those of well- 
known nostrums, or so-called ethical proprietary 
remedies. 

As noted before, this is a class about which 
there exists an honest difference of opinion. When 
we remember, however, that the most meritorious 
of these several nostrums represent very little that 
is original or novel (most of them having been 
appropriated from the prescriptions of well-known 
physicians), and that the claims that are made in 
connection Avith many of them are based largely 
on extravagance and deception, the propriety of 
using supposed imitations of any of them presents 
itself to us in quite a different light. 

To illustrate how very little originality is repre- 
sented by the average proj)rietary medicine and 
how, in not a few cases, the discoverer of the so- 
called new remedy has succeeded in simply dis- 
guising an old and well-known formula by impart- 
ing to it a new flavor, giving it some new color and 
conferrino; on it a new name, we refer to the fol- 



INTRODUCTION. 25 

lowing formulas contained in this late edition of 
the iSTational Formular}^ : 

The formula for "Alkaline Antiseptic'' jDroduces 
a preparation that is suggestive of the widely ad- 
vertised proprietar}^ "Glj^co-Thymoline." From a 
therapeutic point of view this formula is evidently 
l)ased on the old formula for "Compound Solution 
of Sodium Borate" — Dobell's Solution — the only 
evident difference being the substitution of the 
aromatic antiseptics for the "disagreeable" carbolic 
acid and imparting to the solution a characteristic 
color. 

In the National Formulary the formula for 
"Chloral and Bromid Compound" is strongly sug- 
gestive of "Bromidia," but it also calls to mind the 
composition of the very much older and well- 
known English formulas for chloroform anodyne, 
chlor-anodyne and chlorodyne. The American 
"discoverer," it is true, has substituted a huge dose 
of hydrated chloral for a safer dose of chloroform 
and calls the resulting mixture a safe and harm- 
less one, "the hypnotic par excellence." Aside 
from the manifest untruths that are to be found 
in the advertising matter put out by the concern 
manufacturing Bromidia, and the pharmaceutical 
"knack" in preparing it, there is nothing original 
or novel to be recorded in connection with it. 

The Compound Digestive Elixir recalls the 
widely used Elixir of Lactopeptine, which, apart 
from its pretty red color and admittedly pleasing 
taste, has little to recommend it from a thera- 
peutic point of view. 



2G PHARMACOPEIA AND PHYSICIAN. 

What is true of these preparations is also true 
of nearly all this class of mixtures that are now 
being exploited and sold as original preparations ; 
they are original only in so far as they relate to 
the particular manufacturer and represent nothing 
really new or original. 

The few examples enumerated above, therefore, 
serve to indicate that in place of presenting form- 
ulas for imitations of proprietary remedies the Na- 
tional Formulary really reflects how the demands 
of medical practice are met by improved pharmacy, 
to which the manufacturers of proprietaries have 
contributed but little. 

Apart from the question of individual right in 
the formula or the composition of any particular 
preparation, is the fact that many nostrums mar- 
keted through physicians are so sold, advertised, 
prescribed and labeled as to induce self-medication 
by the laity, and many of them are advertised, at 
least indirectly, to the public. When we remem- 
ber that not a few of these preparations repre- 
sent dangerously potent drugs and that all of 
them are a menace to the public health, unless 
their use is intelligently directed, we must admit 
that as physicians we have been sadly remiss in our 
duty as guardians of the public health in even al- 
lowing (to say nothing of fostering) the present- 
day multiplicity of objectionable nostrums. 

Even in connection with preparations that are 
otherwise unobjectionable there are serious abuses 
for which we are directly responsible. Not a few 



INTRODUCTION. 27 

of the manufacturers of medicinal jDrejoarations 
have assumed the role of scientific investigators 
and attempt at least to pose as such before us and 
before the public. In exploiting their wares, how- 
ever, they commonly extol all of their virtues, but 
either minimize their disadvantages or, more fre- 
quently, omit all mention of adverse criticism. 
We would instantly discredit any scientific inves- 
tigator detected in such deception, and if manu- 
facturers continue to attempt to pose as scientific 
investigators we should, in justice to ourselves, 
demand the same standards in the exploitation of 
new remedies that we do in scientific research, and, 
above all, we should insist that we ourselves, be not 
misled by garbled and unreliable reports of the 
wonderful cure-all properties of a new remedy. 

As previously noted, it is our purpose in writing 
the following chapters to arouse and to foster a 
healthy spirit of skepticism regarding the claims 
made by manufacturers in connection with new. 
and in many respects unloiown, remedies, and to 
cultivate, so far as we are able, a desire for autlien- 
tic information bearing on the use of the time- 
tried and generally well-established remedies of the 
Pharmacopeia. To do this it will at times be nec- 
essary to present what may seem elementary and 
well-known facts. If we succeed in making many 
mcml)ers of the medical profession more familiar 
with the drugs and preparations which are included 
in our national Pharmacopeia, wo shall fool that 
we are well repaid for our efforts. 



CHAPTER I. 
GENERAL DISINFECTANTS. 

The important subject of antisepsis embraces so 
many different agents that are used in such a va- 
riety of conditions that any convenient considera- 
tion of them according to their uses, or according 
to tlie principles that are involved, must neces- 
sarily be an arbitrary one. For our purpose we 
shall consider them under three heads: (1) Gen- 
eral disinfectants and antiseptics; (2) local disin- 
fectants and antiseptics, and (3) internal antisep- 
tics. Some substances will require consideration 
under all three headings, but even this will be 
found preferable to giving, for example, all of the 
manifold uses of such an article as mercuric chlo- 
rid in one place. 

Antiseptics were used long before the causes of 
fermentation or of putrefaction were known, and 
it would have been remarkable, indeed, had man 
failed to perceive the effect of those substances 
which are capable of inhibiting a process so com- 
monly encountered. The Egyptians preserved the 
human body against the attacks of putrefactive 
organisms, without any evident Icnowledge of the 
character of the organisms causing decay, by means 
of balsams which contained such antiseptics as ben- 
zoic and cinnamic acids. The epoch-making dis- 
coveries of Pasteur, followed, as they were, by the 
favorable reports on the use of phenol, or carbolic 



GENERAL DISINFECTANTS. 29 

acid, by Lister^ and the subsequent discovery that 
other substances jDOssessing great antiseptic power 
were even less toxic to man, gave tremendous force 
to the pendulum, which w^as carried entirely too far 
by the efforts of well-meaning enthusiasts, and in 
its backward swing much unnecessary skepticism 
has been aroused. 

The rapidly growing importance of preventive 
medicine has raised the subject of sanitation into 
one of prime interest, and the physician must at 
least inform himself on the general principles in- 
volved, including those of disinfection. In this 
connection attention may be called to the very 
general, but erroneous, impression in the lay mind 
tbat all deodorants are disinfectants — an error that 
often leads to dangerous dependence on substances 
which are useless for disinfection. 

While the subject of general disinfection does 
not necessarily form a part of the physician's daily 
consideration, there are occasions when he is sud- 
denly confronted Avith the necessity of directing 
such work, and on tlie thoroughness with which he 
does it will depend the safety of other members of 
the community. While tliere is no great difficulty 
in securing thorough disinfection, it is absolutely 
necessary that certain rules be rigidly complied 
with, and this can not be done without an exact 
knowledge of the object that is to be accomplished 
and of the means of tlio accomplishment. There 
is [)rol)ably no condition wIkm'c a little knowledge 
can ))rovc to be more dangerous tlian in this very 
inaffci- ol' disinfection, and we, therefore, have no 
ajiologics to offci- for going into details on a subject 



30 PHARMACOPEIA AND PHYSICIAN. 

that may be considered commonplace or well un- 
derstood. 

That an ounce of prevention is better than a 
pound of cure is nowhere better demonstrated than 
in the matter of infectious diseases, and we may 
digress in order to consider the means of prevent- 
ing certain communicable diseases. 

Flies are very commonly the carriers of infec- 
tion, and it is important that they should be de- 
stroyed, and, when possible, their breeding pre- 
vented. For the latter purpose all fresh manure 
should be promptly covered with milk of lime to 
prevent the hatching of eggs deposited in the 
manure. Stables should be screened when feasi- 
ble. Milk infected in insanitary stables is one of 
the most prolific sources of disease, and the milk 
supply should be investigated whenever it seems 
probable that it may be the source of infection, 
particularly in scarlet and typhoid fevers, and in 
the diarrhea of infants. In the event that a sani- 
tary condition is unattainable about the stable, 
prompt sterilization of the milk becomes necessary. 

It is well known, through the work of Carlos 
Finlay, Eeed and Carroll, Manson and others, 
that the mosquito is the carrier of the organisms 
concerned in the spread of malaria and yellow 
fever, and the destruction of those pests is, there- 
fore, the first rational step toward the prevention 
of the spread of those diseases. 

The complete extermination of the mosquito is 
not always easy, but precautionary measures will 
always lessen the danger from this source. 

All bodies of still water, whether they be found 
in discarded tin cans or in ponds, may serve as the 



GENERAL DISINFECTANTS. 31 

breeding places of the mosquito, and they should, 
therefore, be drained or covered, in the mosquito 
season, with a thin film of oil at intervals of about 
two weeks. Patients suffering with malaria and 
3^ellow fever should be carefullj'- protected by mos- 
quito nets. 

SUNLIGHT AND HEAT. 

The best of all disinfectants is bright, direct 
sunlight, coming into immediate contact with the 
individual germs, not merely shining on one side 
of a thick garment or carpet, or on small masses of 
sputum, blood, pus or decaying meat, but shining 
on, and penetrating, each individual micro-organ- 
ism. When this can be accomplished all germs — 
not all spores — are killed in a few hours. But 
sunlight is not dependable unless all of the neces- 
sary conditions can be rigidly complied with, as 
may be done with impervious flat surfaces (floors), 
or linen and other thin garments, both sides of 
which may be exposed to the direct rays of the 
sun. The disinfection of articles infected with the 
more virulent pathogenic organisms usually re- 
quires other, more directly active, means than that 
of sunlight, with the attendant danger of further 
dissemination, and chemic disinfectants or heat 
must then be employed. 

The direct flame instantly destroys all forms of 
microscopic life. Dry air, heated to 160° C. (320° 
F.), kills all disease germs — but not all spores — 
in one hour; but wood will begin to char at 180° 
C. (356° F.) and even lower, so that dry hot air 
is not applicable as a certain means of disinfection 
in all cases. Simple drying kills bacteria; but 



32 PHARMACOPEIA AND PHYSICIAN. 

masses of sputum or other organic matter may pre- 
serve the organisms in the interior for an indefinite 
period, while spores are thus preserved for years. 

]\Ioist heat, water or air saturated with aqueous 
vapor, heated to 75° C. (167° F.), is rapidly fatal 
to most bacteria. Water containing typhoid bacilli 
is rendered much safer by heating even to this 
comparatively low temperature for ten minutes. 
Boiling water, on the other hand, will kill even 
spores in ten minutes or more if they are not pro- 
tected in small masses. When such masses do exist 
1 per cent, of soda or soap should be added to the 
water to dissolve the albuminous and other organic 
matter and at the same time to raise the boiling 
point slightly. 

When metallic instruments are to be disinfected 
they may be boiled in water containing caustic 
soda, baking soda or borax, as those substances pre- 
vent rusting. 

Moist steam, or air which is supersaturated with 
steam, is rapidly fatal to pathogenic organisms, 
but superheated dry steam is not so quickly fatal 
as is the moist at a much lower temperature. Pres- 
sure, moisture and increased temperature increase 
the effectiveness of all methods of disinfection. 
Moist steam penetrates better than dry air, but 
heavy fabrics may protect micro-organisms, and 
particularly spores, for "a considerable time, and 
many articles, such as mattresses, can not be read- 
ily disinfected even in this way. 

CHEMICAL DISINFECTANTS. 

Formaldehyd was first obtained by Hoffmann 
in 1867, but its powerful antiseptic properties were 
ol)served bv Loew and Fischer in 1886. 



GEXEIiAL DISIXFECTANTS. 33 

Formaldehyd, or formic aldeliyd. is widely used 
as a disinfectant and sometimes as a food pre- 
servative. Since it has been detected in smoke, 
and even in the atmosphere, it follows that minute 
traces in food may be due to natural causes. The 
amount so absorbed can not be large, since one 
part of the gas renders from 15,000 to 50,000 parts 
of air irrespirable. 

Anderson found great differences in the resist- 
ance of different bacteria to various strengths of 
formaldehyd; thus, the dysentery and white pus 
organisms resisted a 1 per cent, solution for two 
hours, Avhile a 5 per cent, solution required forty- 
five minutes for the destruction of the tubercle 
bacillus in siDutum. 

These results, which are contrary to pretty gen- 
erally conceived opinions, illustrate the importance 
of exact knowledge in the matter of disinfectants. 

Formalin, or formaldehyd, does not actively cor- 
rode metallic instruments, nor does it injure fab- 
rics. The vapor of the strong solution is very 
irritating to mucous surfaces; it combines with 
albumin and on this action depends its germicidal 
properties. 

Tunicliffe and Eoscnheim found that one part 
of formaldehyd to 5,000 of milk interfered Avith 
metaljolism in weak cliildren. 

The disinfectant action of formaldehyd is in- 
creased by moist heat, as in the case of other 
agents. 

From the cxjjoriments that were made in the 
Hygienic Laboratory of the Public Health and 
Marine-Hospital Service, it would appear that for- 
maldihyd gas is not to be depended on, as a germi- 
(■i<lal agent, at tcmpcratni-cs below 1(1° (". ((10° 



:54 PHARMACOPEIA AND PHYSICIAN. 

F.) or when the relative humidity of the atmos- 
phere is below 65°. 

Wliile many of the available references on the 
i^se of formaldehyd gas as a disinfectant are con- 
tradictory, it has been satisfactorily demonstrated 
that the simple presence of dry formaldehyd gas in 
the atmosphere can not be taken as a criterion of 
efficiency and that more, rather than less, than the 
theoretic quantity of gas should always be used. 

The use of solidified formaldehyd. more properly 
known as paraform, paraformaldehyd or trioxy- 
methylen, a polymerized formic aldehyd, has been 
recommended as a source of formaldehyd gas. A. 
A. Young and others, however, have shown that 
paraform can be vaporized and condensed again as 
paraform, and it is highly probable that even un- 
der the most favorable conditions only a portion 
of the substance is converted into actively avail- 
al)le formaldehyd gas. 

Formic aldehyd, or formaldehyd, is now official 
as: 

Liquor Formaldeiiydi. — U. S. P. — Solution of 
Formaldehyd, containing about 37 per cent, by 
weight of formic aldehyd, an oxydation product of 
methyl alcohol. When rooms are to be disinfected 
this substance may be applied directly by washing 
or spraying, or it may be used in the form of 
vapor. For the latter purpose the windows and 
doors are tightly closed, paper being used to stop 
up the crevices, carpets should be removed or sus- 
jicnded and all drawers and closets opened and 
tlicir contents so placed that the vapor will readily 
reach and penetrate every particle of fabric. For- 
maldehyd solution is then vaporized either in the 
room or through the keyhole with enough water to 



GENERAL DISINFECTANTS. 35 

saturate the air in the room. Considerable loss of 
formaldehyd occurs through decomposition during 
vaporization by heat, and it is, therefore, prefer- 
able to saturate sheets with the requisite quantity 
and suspend them in the room which is to be dis- 
infected, or, better still, the solution may be 
sprayed from a suitable atomizer. The keyhole is 
then plugged and the room allowed to stand for 
from 12 to 24 hours. Novy advises 150 c.c. (5 fl. 
oz.) of the 40 per cent, solution, corresponding to 
about 165 c.c. (5% fl. oz.) of the official, for each 
1,000 cubic feet of air space. To increase the efB- 
ciency of the formaldehyd, 3 liters (3 quarts) of 
water are vaporized into each 1,000 cubic feet of 
space. If the atmosphere is damp, less water will 
be required, of course. Under ordinary conditions 
it is cheaper to destroy inexpensive mattresses than 
to disinfect them thoroughly. If they are of 
straw, destruction is readily accomplished by burn- 
ing them out of doors. 

Formaldehyd gas is much less effective in the 
disinfection of rooms containing furniture than it 
is for disinfecting bare walls and flat surfaces. 

For the disinfection of rooms a mixture of 3 
liters of formaldehyd and 3 kilos of unslaked lime 
with 9 liters of boiling water may be used for 50 
cubic meters (1,800 cubic feet) of space. The lime 
is placed in a tub holding about 25 gallons, tlie 
water poured on it and the formaldehyd added, the 
room being closed for some hours. 

The resulting milk of lime may be used after- 
wards for the disinfection of feces and for other 
l)urposes enumerated later. 

Another method of generation that is frequently 
recommondc'd consists in placing from six to eight 



■Mi PHARMACOPEIA AND PHYSICIAN. 

ounces of potassium permanganate in a capacious 
tinned iron container and pouring on it 16 fluid- 
ounces of the official solution of formaldehyd. The 
reaction that follows is a complicated one, but 
takes place with great violence and several serious 
fires have been reported as the direct result of the 
spontaneous combustion of the evolved gas. To 
obviate this, it has been recommended to guard 
against the presence of organic matter and to 
place the generating container in a larger vessel, 
or tin tub, containing water. 

The fumes of ammonia have a strong affinity 
for formaldehyd gas and the last traces of the lat- 
ter may be readily absorbed by exposing a small 
quantity of ammonia in the room after it has been 
fumigated. 

Calx. — U. S. P. — Lime, calcium oxid, consti- 
tutes an inexpensive and very useful disinfectant 
that has a number of widely varying uses. In- 
fected urine, vomit and feces may be thoroughly 
disinfected by being received into a vessel that 
contains freshly prepared milk of lime. It is es- 
sential that this be freshly prepared, as calcium 
hydrate rapidly absorbs carbon dioxid from the 
air and is thereby changed into the inactive cal- 
cium carbonate. Milk of lime may be prepared 
by putting a few pounds of lime into an iron pot 
and adding about half as much water; the lime 
rapidly falls into a dry powder with the evolution 
of heat; to this powder add three times, as much 
water and stir well. The resulting mixture will 
keep for several days without deteriorating suffi- 
ciently to be inert. There are, of course, several 
precautions to be observed : The lime must be re- 
cently calcined, or fresh, and the person who slakes 



GENERAL DISIXEECTAXTS. 37 

it should be careful to avoid the irritant dust 
which arises during the process; then, too, the 
heat generated may be sufficiently high to char 
Avood or to set fire to readily combustible ma- 
terials. For disinfecting feces or other substances 
they should be thoroughly stirred with an equal 
quantity of the milk of lime, or, better still, with 
twice the quantity, the mixture being allowed to 
stand for two hours. 

Milk of lime is also useful for disinfecting floors, 
cellars, cesspools after draining, and even walls 
when they are not subject to injury. It must al- 
ways be remembered that this whitewash rapidly 
absorbs carbon dioxid and thus becomes inert, 
hence the mixture is an efficient disinfectant, but 
it is not useful as an antiseptic. 

Unslaked lime is a cheap and very efficient 
means of destroying animal matter and is also use- 
ful for absorbing moisture in damp cellars. As 
noted before, certain precautions are always to be 
taken in connection with this really active chemi- 
cal substance. Cesspools are difficult to disinfect. 
Large quantities of milk of lime are effective, but 
the contents must be thoroughly mixed with the 
disinfectant, whatever its nature. 

Hydhaijgyri Chloridum Corrosivdm. — U. S. 
P. — Corrosive Mercuric Chlorid, bichlorid of mer- 
cury, mercuric chloric!, or, as it is most commonly 
called, corrosive sublimate^, will l)c considered more 
extensively in connection with local antiseptics. It 
has, however, a number of very iinpni-tant uses in 
connection with disinfectants. 

Corpses of persons dead of ;iii inrccliuns disease 
should he iniiticdiatcly wmppcd in cloths siitnratod 



38 PHARMACOPEIA AND PHYSICIAN. 

with a 1 to 1,000 solution of mercuric chlorid. The 
addition of 20 per cent, of glycerin to the solution 
of mercuric chlorid will prevent the rapid evapora- 
tion of the water, which leaves the mercuric chlorid 
as a dry powder in the cloth. Water which has 
been used to bathe a person suffering from an in- 
fectious disease, such as tj^phoid fever, should be 
disinfected by heating to near the boiling point or 
by the addition of a liberal quantity of milk of 
lime or a much smaller quantity of mercuric chlo- 
rid. If the bathtub is of metal, the latter chemical 
should not be used, but phenol or cresol may be 
substituted. 

Ferri Sulphas. — U. S. P. — Ferrous Sulphate, 
preferably the impure or crude article, commonly 
called copperas, is an excellent deodorizer for ani- 
mal excretions, the iron uniting with the albumin 
and the acid with the ammonia; it is not a very 
active disinfectant. 

CuPRi Sulphas. — U. S. P. — Copper Sulphate, 
or blue vitriol, may be similarly used, but it is 
much more expensive and possesses no marked ad- 
vantages over copperas as a deodorizer. 

Sulphur Sublimatum. — IT. S. P. — Sublimed 
Sulphur, or flowers of sulphur, is frequently 
burned as a disinfectant, in rooms which contain 
nothing which can be injured by the corrosive ac- 
tion of the resulting sulphurous oxid. It is not so 
frequently used now that formaldehyd affords a 
more satisfactory means of disinfection, but it is 
cheaper and may be 'used to advantage in cellars 
and in empty rooms, that can be thoroughly sealed. 
Hoppe-Seyler recommends that 15 gm. (% oz.) 
be burned for every cubic meter (cubic yard) of 



GENERAL DISINFECTANTS. 39 

space. This would be equivalent to about 450 gm. 
(15 oz.) for 1.000 cubic feet. Eooms should be 
left tightly closed for from twenty-four to forty- 
eight hours, then the remaining fumes may be 
readily absorbed by sprinkling ammonia in the 
room. As with formaldehyd disinfection, the 
vapor must come into actual contact with the 
micro-organisms and the atmosphere should con- 
tain moisture. This latter requirement is usually 
met by burning the sulphur in a double vessel, the 
outer one containing water. 

The gas that is generated by the burning of sul- 
phur is very poisonous to man, due to its local 
corrosive action. Spasmodic closure of the glottis 
may occur, causing death. Sulphurous oxid, the 
substance that is thus generated, remains free in 
mixtures of organic matter longer than free chlo- 
rin, hence it is a more effective bactericide. 

Owing to the poisonous nature of this gas. for 
all forms of animal life, it has been widely used to 
destroy vermin in infected rooms. It is much more 
efficient for this purpose than formaldehyd, thougli 
not so satisfactory as hydrocyanic acid gas; the 
latter; however, is extremely poisonous and must 
be handled with great caution. 

Calx Ciilorinata. — U. S. P. — Chlorinated 
Lime, popularly, though improperly, called chlorid 
of lime, is a ready source of chlorin and is a very 
convenient and inexpensive disinfectant suitable 
for many of the purposes for which sulphurous 
oxid might be used. Chlorin, like sulphurous oxid, 
is very corrosive, attacking metals, and bleaching 
and destroying fabrics. Chlorinated lime is useful 
for sprinkling about urinals, damp cellars, out- 



40 I'HAh'MACO/'EIA A\D PHY.'^ICIAN. 

houses, stables and drains. It deteriorates rapidly 
on exposure to the air and onl}^ tightly sealed 
packages from reliable firms should be used. 

Empty rooms may be disinfected with chlor- 
inated lime when the walls can not be injured by 
the liberated chlorin. For this purpose 3 pounds 
of the chlorinated lime are used for each 1,000 
cubic feet of space. It is placed in an earthen 
vessel, and a considerable amount of mineral acid 
is added, the room being left tightly closed for 
some hours. The gas is very poisonous and should 
not be inhaled. 

The various solutions of chlorids that are sold 
at fancy prices are usually feeble and are in nowise 
superior to a readily made mixture of a quarter of 
a pound of chlorinated lime with half a gallon of 
water. The admixture of an acid at the time of 
using causes the rapid liberation of chlorin and 
increases the disinfectant action. 

Liquor Sod^ Chlorinat.^. — U. S. P. — Solu- 
tion of Chlorinated Soda, the so-called Labar- 
raque's solution, is but another form of a chlorin 
compound. It has the one advantage of being free 
from insoluble caustic material.^ 

Phenol. — U. S. P. — Phenol, the Acidum Car- 



1. Where an Inodorous deodorant is required it will be 
found that the Liquor Zinci et Alumini Compositus of the 
National Formulary will give be'tter and more uniform satis 
faction than proprietary articles of the same type. It is 
made as follows : 

J^. Zinci sulphatis __ I 

Alumini sulphatis, ua 3xxvii 1001 

Betanaphthol gr. v 13 

Olei thymi gr. xv 1 

Aquce, q. s. ad 01 500 1 

The salts are dissolved with the aid of heat and the vol- 
atile substances added to the solution. 

Still another prepai-ation of the same type Is the Liquor 
/.inci et Ferri Compositus — N. F. 



OEXERAL DISIXFECTAyrti. 41 

bolicum of the U. S. P. 1890, is much more ex- 
pensive than, and not nearly so efficient as a disin- 
fectant as : 

Cresol. — U. S. P. — Cresol has been included in 
place of the formerly official crude carbolic acid. 
It is a mixture of the three isomeric cresols found 
in coal tar, and is a useful and highly efficient 
disinfectant and antiseptic. 

Liquor Cresolis Compositus. — U. S. P. — 
Compound Solution of Cresol consists of a mix- 
ture of equal parts of soap and cresol. When 
properly made this mixture is an admirable sub- 
stitute for any one of the numerous soluble or 
semi-soluble proprietary preparations containing 
cresol ; such as creolin, cresolin, lysol, lysitol and a 
host of others too numerous to mention. 

Compound solution of cresol is practically iden- 
tical with tlie Liquor Cresoli Saponatus of the 
German Pharmacopeia; it is miscible in all pro- 
portions with water, and, as noted before, is a re- 
liable and readily available disinfectant. 

One part of the comjDOund solution of cresol 
added to twenty parts of very warm water is useful 
for the sterilization of surgical instruments, and a 
sliglitly weaker solution, made by adding one part 
to tliirty of wnnn wad'i'. nlTords an excel IcMit disin- 
fectant for the liaiids. 

PoTASsi Peh.mangax.vs. — U. S. p. — Potassium 
Permanganate attacks all forms of organic nuitter 
and is generally nsd'nl In!- the (l('sii'iic(ii)n of foul 
odors. l)ut is not \cr\ \\>('\'u\ as a disinrcctanl. It 
will be considci'i'd later a! greater lengtli. 

The strong mineral acids are destructive to bac- 



4-2 PHARMACOPEIA AND PHYSWIAN. 

toria, but their application as disinfectants is nec- 
essarily very limited. 

As noted before, mercuric chlorid is to be classed 
with the most powerful of all disinfectants in gen- 
eral use, one part in 10,000 being fatal to spores. 
Like all other chemical disinfectants, its activity 
is increased by heat. It precipitates albumin and 
its efficiency is, therefore, materially lessened by 
the presence of any appreciable amount of such 
organic material; this disadvantage of mercuric 
chlorid may be obviated in part by the addition 
of an equal amount of sodium or ammonium 
chlorid (or a small amount of hydrochloric acid), 
the tablets found on the market for preparing the 
solutions always containing the requisite quantity 
of one of those salts. As it attacks metals, it is 
not suited for the disinfection of instruments or 
metallic vessels. One part of mercuric chlorid in 
50,000 parts of water has been demonstrated to 
possess decidedly antiseptic properties. Its com- 
parative non-volatility, its property of attacking 
metals and of combining with albumin, and its 
extreme toxicity limit its field of application, but 
it remains by far the cheapest antiseptic we have 
for general use. 

Copper sulphate shares with copperas (crude 
ferrous sulphate) the power of deodorizing decom- 
posing organic matter, though it is but little used 
for this purpose. It has recently been claimed that 
the merest trace of copper sulphate, or of copper, 
in water readily destroys the bacillus of typhoid 
fever, or at least completely inhibits its growth; 
even though the copper is present in quantities 
too small to interfere with the use of the water for 



GENERAL DISINFECTANTS. 43 

drinking. The results of different investigators 
are not uniform, however, and some maintain that 
the antiseptic power of copper and its salts has 
been greatty overestimated. The soluble salts of 
zinc, particularly the chlorid, have also been used 
for disinfecting purposes, but as they share with 
copper the disadvantage of being comparatively 
expensive, without any accompanying material ad- 
vantages, a more detailed consideration of these 
substances may be omitted in this connection.^ 

CLINICAL THERMOMETEES AND HYPODERMIC 
SYRINGES. 

The disinfection or sterilization of clinical ther- 
mometers and of hypodermic syringes and needles 
deserves especial mention. With the present com- 
paratively low price of clinical thermometers there 
is little or no excuse for not having an individual 
thermometer for each patient ill with an infec- 
tious or a contagious disease or a continued fever. 
But, even this precaution, desirable as it certainly 
is, does not obviate the necessity for disinfecting 
or sterilizing the thermometer. The necessary dis- 
infection may be effected in any one of a number 

2. The following quotation, talcen from Wood's "Thera- 
peutics," page 823, contains suggestions that are of interest 
in this connection. "There are not many affairs in life in 
which the public has been so superabundantly fleeced as in 
the matter of disinfection. A most extraordinary part of 
this swindling is the ease with which distinguished members 
of the medical profession have given certiflcates of efliciency 
and value to comparatively Inert and extraordinarily expen- 
sive proprietary compounds. Oddly enough, the cat that has 
drawn the chestnuts out of the lire for avaricious manufac- 
turers has not even had the sense to smell the odor of its 
own paws when burning." It is evident that Dr. Wood 
knew less of the resources and the wiles of nostrum makers, 
and llielr shrewdness in duping physicians, than he supposed, 
else he would not think It extraordinary that so many have 
been deceived. 



44 J'HAIx'MACOI'EIA AND PHY>ilClAN. 

of ways ; the thermometer may be dipped for a few- 
minutes in strong plienol, the solution of cresol, or 
in the, now official, solution of formaldehyd, after 
which it is thoroughly rinsed in water. Where an 
individual thermometer is provided it may be ster- 
ilized by keej^ing the l)ulb immersed in 75 per cent, 
alcohol, a saturated solution of boric acid, the of- 
ficial liquor antisepticus, or in a mixture of equal 
parts of antiseptic solution and of solution of hy- 
drogen dioxid. It must appear even to the least 
careful that the disinfection of clinical thermom- 
eters is a precaution so important that it should 
never he neglected. 

The hypodermic syringe and needle should be 
disinfected with strong phenol or cresol solutions, 
solution of formaldehyd or by repeated washing 
with very hot water as a purely routine procedure. 
When a syringe and needle are known to be in- 
fected the disinfection should be as thorough as 
that of other surgical instruments. 

Solutions intended for hypodermic injection 
can be sterilized by boiling, when this does not 
cause decomposition. With the now widely used 
hyjDodermic tablets it is preferable to boil the nec- 
essary quantity of water, or, better, distilled water, 
for a minute or two, then add the tablet, avoiding 
all unnecessary handling, and warm sufficiently to 
insure thorough solution. Cocain, being readily 
decomposed, can not be boiled, but the solution 
may be sterilized by heating to about 80° C. (176° 
F.) for thirty minutes on two successive days. It 
is usually preferable, however, to use freshly pre- 
pared solutions that have been made in a sterile 
bottle with recently boiled and sterile distilled 



GEXERAL DIfilXFECTAyTS. 45 

water. Eiicain and stovain solutions may be boiled, 
but these substances themselves are not entirely 
free from objections. 

Under the subject of internal antiseptics we 
shall have occasion to mention the disadvantages 
of sterilized milk, but here we may call attention 
to the widespread use of formaldehyd, salicylic 
and boric acids, borax and other chemical antisep- 
tics for the preservation of foods. While we are 
not certain that minute quantities of many of 
these chemical antiseptics are in themselves in- 
jurious, we have ample authority for the opinion 
that their continued use in appreciable quantities 
is by no means beneficial. Schmiedeberg regards 
the constant use of even small quantities of sali- 
cylic acid, for a continued period, as imwise in the 
present state of our knowledge, and Sollmann says 
that the use of formaldehyd can not be too strong- 
ly condemned, because of the specific irritation of 
the mucous membranes which it causes. 

Liebreich has written a number of treatises on 
the use of boron compounds as food preservatives, 
but The Prussian Scientific Deputation on Medical 
Conditions gives a written opinion at the request 
of the Berlin police, in which the conclusions of 
Liebreich are rejected, and these preparations are 
])ronounced injurious to the human organism even 
when taken in small quantities. 

The whole subject of food preservatives, from its 
vital importance, is one in which the physician 
should, and indeed must, be actively interested, 
but it is entirely too extensive to be discussed at 
length here. 

The subject of preservatives is also of interest 



40 PHARMACOPEIA AND PHYSICIAN. 

in connection with medicines and medicinal prepa- 
rations. The antiseptic action of alcohol, glycerin, 
sugar and of volatile oils is well known and gen- 
erally recognized, and, while not of sufficient im- 
portance to be considered in connection with gen- 
eral disinfection, these substances are widely used 
as preservatives not alone for medicinal prepara- 
tions and foods, but also for other substances. The 
use, or abuse, of preservatives in connection with 
medicinal preparations, particularly in connection 
with proprietary remedies, is a matter that is de- 
serving of more attention than is now being ac- 
corded it; as the presence of preservatives un- 
doubtedly influences the physiologic action of other 
ingredients. 



CHAPTER II. 

LOCAL DISmFECTANTS AND ANTISEP- 
TICS. 

Lister's use of local antiseptics in surgery is 
usually spoken of as a discovery, but, without de- 
tracting in any way from the credit due to Lister, 
it should be referred to more correctly as a prac- 
tical application of previous discoveries. 

Eeicbenbach, in 1832, obtained a substance from 
wood tar which he named creosote. Finding later 
that it consisted of phenol and phenol ethers, and 
also finding these same substances in smoke, he 
concluded, and later conclusively proved, that to 
them is due the meat preserving activity of smoke. 

Runge, in 1834, found that the phenol which 
ho obtained from coal tar also possessed the power 
of preventing putrefaction. Tar and a number 
of products of a similar nature were long ago rec- 
ommended and widely used for foul smelling ul- 
cers, but the fact remains that to Lister is univer- 
sally, and very properly, accorded the distinction 
of having placed antisepsis in surgery on a sure 
basis. Since the early days of antisepsis there 
have been many improvements, and we now know 
that the most perfect cleanliness, or asepsis, that 
is attainable is much to be preferred even to the 
most elaborate antisepsis. 

It is, of course, entirely beyond the scope of 
this treatise to consider the details of major surg- 
ery, but the principles of antisepsis which obtain 
in this branch are equally applicable to minor 



48 PHARMACOPEIA AND PHYSICIAN. 

operations, and their disregard by many, who are 
not surgeons, is the best justification for their 
present brief consideration. Tlie necessity for 
scrupulous cleanliness is seen in such a common, 
but admittedly important, procedure as vaccin- 
ation. The careful physician will perform even 
this simple operation under aseptic conditions, 
thereby saving himself much annoyance in case 
of accident. 

The first, and really the most important, duty 
of the physician with regard to infections is to 
see that he does not carry them to other patients. 
There can be no doubt that physicians have played 
no small part in the spread of infectious diseases, 
particularly in the past, but fortunately, with the 
better understanding of the subject, this occurs 
now less frequently than it did formerly. 

The disinfection of clothing and of instruments 
belongs to the subject of general disinfection, that 
of the hands and person to local disinfection. 

The cleansing of the hands, as it is done in a 
number of American hospitals, is about as fol- 
lows : "Trim and clean the nails, wash the hands 
and forearms for five minutes in very warm, 
sterile water, using soft soap or a liquid soap^ and 

1. An efficient and satisfactory liquid soap can be pre- 
pared by any pharmacist from the following formula : 

Sodium hydrate 40 Gm. 

Potassium hydrate 40 Gm. 

Cottonseed oil 500 Cc. 

Alcohol 250 Cc. 

Distilled water, a sufficient quantity to 

make 2500 Cc. 

In a suitable container, preferably a glass-stoppered bottle, 
dissolve the potassium hydrate and the sodium hydrate in 
250 Cc. of distilled water, add the alcohol, and then add the 
cottonseed oil in three or four portions, shaking vigorously 
after each addition. Continue to agitate the mixture occa- 
sionally until saponification has been completed. Then add 
the remaining portion of distilled water and mix. 



LOCAL ANTISEPTICS. 49 

scrubbing them energetically with a brush or a 
gauze pad, cleansing the nails again during this 
part of the process. Rinse the hands for three 
minutes in 75 per cent, alcohol, to remove soap and 
to aid in sterilization; then in 1 to 1,000 solution 
of mercuric chlorid, or in a solution of 1 to 2,000 
mercuric chlorid with 1 to 40 phenol, and finally 
]-inse in sterile warm water." This may be some- 
wliat more elaborate than is necessary in most cases 
of minor surger}^, but even here it is well to err 
on the safe side. 

For the disinfection of the whole body a full 
bath in warm water with the liberal and judicious 
use of soap is sufficient, and the clothes may un- 
dergo disinfection separately at the same time. 
This procedure is so simple that the physician 
can not escape blame should he carry infection 
from one patient to another through the omission 
of necessary precautions. 

When minor surgical operations are to be per- 
formed it is always well to thoroughly disinfect 
the surface at and around the prospective seat of 
operation. For this purpose the procedure given 
for cleansing the hands of the surgeon is sufficient, 
though in some cases it may be found necessary 
to supplement the soap and water with oil of tur- 
pentine. 

Wounds and ulcers require disinfection to de- 
stroy those bacteria which can be reached, and 
antiseptic dressings to prevent the development of 
colonies from those which escape destruction or 
which may afterward reach the spot. 

Tlio compound solution of iodin has been used 
to disinfect cysts in which pntrofactive processes 



50 PHARMACOPEIA AND PHYSICIAN. 

are going on, bnt tliis jKocess is extremely painful 
and sometimes dangerous. It is not recommended. 

Aqua Hydrogenii Dioxidi.- — U. S. P. — Solu- 
tion of H3^drogen Dioxid, or, as it is frequently 
called, Solution of Hydrogen Peroxid, is useful for 
decomposing pus, in which bacteria are protected 
from the action of other disinfectants. It thus 
secures the rapid cleansing of freely exposed pus 
cavities or ulcers, and at the same time it acts 
powerfully on bacteria, though they are not all 
destroyed so long as any pus remains. The offi- 
cial solution is equal, in disinfectant power, to a 
1 to 1,000 solution of mercuric chlorid. The ac- 
tion on pus of hydrogen dioxid is so extremely 
rapid that it frequently detaches small masses 
which may escape decomposition. 

The use of this solution is not unattended with 
risks, particularly in sinuses or deep, partially 
closed, wounds. Mucous membranes decompose 
hydrogen dioxid rapidly, and the skin slowly, with 
the liberation of nascent oxygen. It is not certain 
whether the bactericidal property is due to the 
liberation of oxygen alone, or whether the prepara- 
tion possesses a special influence on the micro- 
organisms. The decomposition whereby the oxygen 
is liberated is supposed to depend on a ferment, 
catalase, which is widely distributed, and, as the 
preparation loses its bactericidal powers, once the 
oxygen has been liberated, it is, of course, useless 

2. It is commonly, but erroneously, believed that the 
amount of free gas confined in the bottle is an index of the 
value of the solution of hydrogen peroxid. It is, in fact, 
an index of the amount of decomposition that has occurred. 
Many manufacturers of hydrogen dioxid now use acetanilid 
as a preservative. When such a solution develops an odor 
resembling nitrobeuzol it should be discarded. 



LOCAL ANTISEPTICS. 51 

as an antiseptic, though extremely useful as a 
disinfectant. Hydrogen dioxid has an especial 
reputation in the treatment of sore throat and 
even diphtheria, for which it is used as a spra}^ 
or as a gargle, with entire safety. It attacks met- 
als readily, and only rubber or glass should be 
used in connection with it. Diluted with an equal 
amount of water, it is an excellent wash for the 
mouth and throat, but not infrequently it contains 
a little acid, and the mouth should be rinsed after 
its use.^ 

After the disinfection of ulcers and wounds an 
antiseptic dressing is applied. Cotton, gauze and 
lint impregnated with various antiseptics are 
found on the market. Only the active substances 
that are used in this connection will be discussed, 
as the application of dressings belongs to surgery. 

IoDOFOR]\[Uir. — IT. S. P. — Iodoform, Tri-iodome- 
thane is usually obtained by the action of iodin 
on alcohol, in the presence of an alkali or an al- 
kaline carbonate. Iodoform was discovered by 
Serullas, in 1822, but was not used in medicine 
until some time after 1837. Despite its disagree- 
able penetrating odor, iodoform continues to hold 
first place among local antiseptics, used for the 
dressing of wounds. At first it was supposed to 
share with chloroform (from which it differs chem- 
ically only in containing iodin in place of the 
clilorin) a strong antiseptic action, but in the case 
of iodoform this has been found to be but slight; 
it is, however, materially increased by the slow 

■'!. An aRrcrcable, and at the samp time efUcicnt, month 
wash Is oljtalnofl by mixing equal parts of aqua hydrofronll 
flioxldl, liquor antlseptlcus (U. S. P.) and a saturated solu- 
tion of potassium chlorate. 



52 PHARMACOPEIA AND PHYSICIAN. 

liberation of iodin. When its local use as a dress- 
ing is long continued, enough of it nia}^ be absorbed 
to produce poisoning, which does not, however, re- 
sult in typical narcosis, such as. chloroform pro- 
duces, but gives rise to disturbances of cerebration, 
headache, delirium and other symptoms. These 
are due to the iodoform molecule; but exanthem- 
ata, which are sometimes severe, are usually attrib- 
uted to the liberated iodin, which, when liberated, 
is thought to circulate in the blood as an alkaline 
iodid or in combination with albumin. Hem- 
aturia, albuminuria and urinary casts may also 
result from its absorption, and many attempts have 
been made to find a substitute for iodoform with- 
out its poisonous effects. 

Some surgeons deny that iodoform exerts any 
direct antiseptic power, and attribute the bene- 
fits from its use to its limitation of the secretion 
on which the bacteria would otherwise develop. 
Binz observed that iodoform lessened the emigra- 
tion of leucocytes, and it is said to be particularly 
useful in local affections with free secretions. 

When iodoform is intended for use as a dust- 
ing powder, its odor may be rendered very much 
less disagreeable by incorporating with it from 1 
to 4 per cent, of cumarin. The following has 
been used to some extent: 

B. lodoformi 3v 20 

Ciimarini gr. xv 1 

Acidi borici q. s. ad Sxiii 50 

Misce bene. 

Sig. : To be used as a dusting powder. 

Pulvis Iodoform! Compositus (N. ¥.), contain- 
ing iodoform 20, boric acid 30, naphthalin 47, 
and oil of bergamot 3 parts, also constitutes a use- 



LOCAL ANTISEPTICS. 53 

ful and comparatiyely unobjectionable antiseptic 
dusting powder. 

Where iodofonn is to be used in the form of an 
ointment the addition of from 5 to 10 per cent, of 
balsam of Peru, or of 2 per cent, of oil of anise 
lias been found to be advantageous. The addition 
of oil of anise, in somewhat larger quantities, has 
also been recommended for iodoform gauze, par- 
ticularl}' when the gauze is to be used in appre- 
ciable quantities or for an}' continued length of 
time. 

If the antiseptic action of iodoform is due to the 
liberated iodin, then necessarily many of the pro- 
posed substitutes must be practically devoid of an- 
tiseptic power, since the iodin is too firmly bound 
to be liberated by the tissues. 

loDOLUM. — TJ. S. P. — lodol, designated chemic- 
ally as tetra-iodopyrrol, is one of the recent addi- 
tions to the Pharmacopeia. The iodin in this case 
is so firmly bound that the substance has been 
recommended as being comparatively non-toxic, 
but iodin is liberated in the body, being excreted 
as iodid. Other preparations, such as nosophen, 
losophan and curophen, depend largely for their 
antiseptic action on the cresol or the phenol com- 
pounds united to the iodin. Loretin and vioform 
arc combinations of iodin and quinolin, and there 
is no reason to suppose that they have any advan- 
tage over the other preparations just mentioned. 

TiTYMOLTS loDiDUM. — U. S. P. — Thymol Iodid, 
much better known by the formerly trademarked 
name "Aristol," is a condensation product of two 
molecules of thymol with two atoms of iodin, and 
more propci'ly, therefore, should be designated by 



54 PHARMACOPEIA AND PHYSICIAN. 

its true chemical title, clithymol di-iodid. This 
preparation, which really belongs to the phenol 
group of iodin compounds, has met with a better 
reception than many of the other iodoform sub- 
stitutes. It is probable, now that the patents have 
expired on aristol and the substance is available 
at much more reasonable prices, that its popular- 
ity and use will be extended gtill further. This, 
however, is problematic. Schmiedeberg specific- 
ally states that aristol, losophan, sozoiodol, picrol, 
loretin and antiseptol, all of which contain iodin, 
are not more actively antiseptic than are the cor- 
responding iodin free compounds, while the latter 
are, of course, much less expensive. Since the 
number of possible combinations of this t^^pe is 
practically unlimited, we will do well to exercise 
circumspection in accepting those which appear 
from time to time. 

Phenol. — A sharp distinction is to be drawn 
between the anesthetic and antiseptic uses of 
phenol. Solutions of phenol in oil, or mixtures 
with fats, are excellent anesthetics when brought 
in contact with painful surfaces or wounds, but 
they possess very little antiseptic action, because 
phenol is more soluble in fats and oils than in 
water or weak saline solutions, hence it does not 
leave the oil to penetrate the bodies of bacteria, 
without doing which it does not injure them. 

Practically the same holds true of its affinity 
for alcohol, and it is for this reason that alcohol is 
such an excellent antidote for carbolic acid, exter- 
nally as well as internally. The absorption of 
phenol is followed by its appearance in the urine, 



LOCAL ANTISEPTICS. 55 

which usually becomes dark-greenish or nearly 
black in color. 

The toxicology of ^ohenol deserves a passing no- 
tice. Despite the well-known fact that it occasions 
great pain when swallowed, it was selected as the 
agent of destrnction by more than one-third of all 
those who committed suicide by poison in England 
for a number of years. It is probable that poison- 
ing by it is equally frequent in this country. 

Sodium sulphate is commonly stated to be the 
proper antidote, though experiments made on ani- 
mals have never demonstrated that it possessed anj 
very decided value, and Sollmann and Brown have 
recently shown that it has practically no effect on 
the course of the poisoning. 

Kobert relates that each of two children swal- 
lowed a teaspoonful of liquefied phenol; ten min- 
utes afterward their stomachs were washed out 
and their lives were thus saved. 

Phenol. — U. S. P. — (Acidum Carbolicum U. 
S. P., 1890) is hydroxybenzene ; it may be obtained 
from coal tar by fractional distillation and subse- 
sequent purification, or it may be made synthetic- 
ally. In its pure state it occurs as colorless, needle- 
shaped crystals, or as a white crystalline mass. 

Phenol Liquefactum. — U. S. P. — Liquehed 
Phenol, Liquid Carbolic Acid, contains from 85 to 
89 per cent, of absolute phenol, and is the form 
in which phenol is usually seen and used. When 
first prepared this solution is colorless, but it fre- 
quently develops a reddish tint on keeping, 

Piienol is now used as an antiseptic dressing for 
wounds very much less frequently than it was some 
years ago, because of tlio danger of poison due to 



56 PHARMACOPEIA AND PHYSICIAN. 

absorption. It may be applied in the form of a 3 
per cent, solution in water; stronger solutions are 
used, but many cases of gangrene have followed 
the use of even dilute solutions on the extremities, 
particularly the hands, for a continued length of 
time. 

Cresol. — U. S. P. — and its more desirable form : 

Liquor Cresolts Compositus. — TJ. S. P. — ■ 
Compound Solution of Cresol is well known and 
has been extensively used, particularly in the form 
of one or the other of the numerous projjrietary 
preparations, as a local disinfectant and also as an 
antiseptic. The saponaceous properties of this 
particular preparation make it very useful in a 
variety of instances in which a detergent action is 
to be attained in addition to the disinfection. 

Thymol. — TJ. S. P. — This is a phenol occur- 
ring in the volatile oil of Thymus vulgaris and in 
some other volatile oils. It possesses strong anti- 
septic properties, but its comparative insolubility 
in water, 1 in 1100, has interfered materially with 
its extended use. Thymol iodid, the only official 
combination of thymol, has been referred to in con- 
nection with iodoform substitutes. 

An ideal disinfectant, or antiseptic dressing for 
wounds, should act not strongly on the living pro- 
toplasm, should be slowly absorbed, and should af- 
fect the central nervous system but slightly after 
absorption. Phenol has the disadvantage of being 
rapidly absorbed and of profoundly affecting the 
central nervous system. Thymol, being but slight- 
ly soluble in water, but volatile at ordinary tem- 
peratures, is slowly absorbed, and, as its excretion 
keeps pace with its absorption, there is little dan- 



LOCAL ANnSEPTIGS. 57 

ger that it will exert a poisonous action when used 
locally. 

The practice of dermatology involves a special 
knowledge of antisepsis, and the subject can be 
given only general consideration at this time, so 
that we must content ourselves with little more 
than a simple enumeration of some of the official 
substance's that are used, merely suggesting the 
number and variety of the available materials. 

Eesorcixol. — U. S. P. — (Eesorcinum U. S. P. 
1890), a diatomic phenol that is usually referred 
to by its popular name, resorcin, was at one time 
extensively used in dermatologic practice, but is 
now seldom employed except for scalp diseases and 
sometimes internally. 

Pyrogallol. — U. S. P. — This is better known 
as pyrogallic acid and is a triatomic phenol, some- 
times used in dermatologic practice. 

AciDUM Salicylicum. — IT. S. P. — Salicylic 
Acid has been used to some extent as a local anti- 
septic, particularly in the form of dusting powders, 
diluted witli talcum, zinc oxid or boric acid. Sali- 
cylic acid is used extensively in dermatologic prac- 
tice, particularly in the form of ointment. It is 
only slightly soluble (1/310) in water. 

Pix LiQUiDA. — U. S. P. — Tar, a product ob- 
tained by the destructive distillation of the wood 
of one of several species of Pinus, has been widely 
used in the treatment of skin diseases, usually in 
the form of an ointment. 

Unguentui^i Picis LiQUiD^rE. — U. S. P. — Tar 
Ointment contains 50 per cent, of tar. 

Oleum Cadixum. — U. S. P. — Oil of Cade, or 
oil of juniper tar, is a product of the dry distilla- 



5S PHARMACOPEIA AND PHYSICIAN. 

tiou of J'lmipm-us Oxycedrus and is closely allied 
to tar, being used in the same way, 

Balsamum Peeuvianum. — U. S. P. — Balsam 
of Peru will be referred to again imder expector- 
ants. Its antiseptic properties are probably due to 
the benzoic and cinnamic acids which it contains. 
It is used in dermatology,, either in ointment or in 
collodion. 

Naphthalenum. — U. S. P. — Naphthalene or 
naphtalin 'and 

Betanaphthol. — U. S. P. — Naphtol, are used 
in dermatologic practice, though the former, at 
least, has practically fallen into disuse for medici- 
nal purposes. 

Among other substances having antiseptic prop- 
erties, used locally, we have : 

Sulphur Peecipitatum. — U. S. P. — Precipi- 
tated Sulphur. This and the other official forms 
of sulphur will be mentioned also in connection 
with cathartics. Sulphur constitutes a most im- 
portant agent in the treatment of a number of skin 
diseases. It is applied either in the form of lo- 
tions or of ointments. For the former, precipi- 
tated sulphur is usually preferred, while in oint- 
ments either 

SuLPHUE SuBLiMATUM. — U. S. P.— Sublimed 
Sulphur, or 

Sulphur Lotum.— U. S. P.— AVashed Sulphur 
is used. In the official 

Unguentum Sulphueis. — U. S. P. — Sulphur 
Ointment, 15 per cent, of washed sulphur is di- 
rected to be used. This ointment is now only half 
the strength of that formerly official and is, there- 



LOCAL ANTISEPTICS. 59 

fore, better suited as a mildly stimulating anti- 
septic application. 

SoDii Thiosulphas. — U. S. P. — Sodium Thio- 
sulphate, better known as sodium h3-posulphite, is 
another useful antiseptic that is now little used 
medicinally, except in dermatology. It is freely 
soluble in water and is usually prescribed in the 
form of a lotion. It is said to be particularly use- 
ful in the destruction of parasitic fungi which in- 
fest the skin. 

Glycerixum. — U. S. P. — -Glycerin is not alone 
useful as a mild antiseptic, but is also extensively 
used as a vehicle for many other substances in the 
treatment of skin lesions. 

Glyceritum Amyli. — U. S. P. — Glycerite of 
Starch is a preparation that was introduced many 
years ago to serve as an ointment base in cases in 
which lard or fat might prove objectionable. It 
was formerly used as a poultice in erythema, ery- 
sipelas, furuncle and various other local inflamma- 
tions of the skin, and may be considered as the 
prototype of the almost innumerable glycerin clay 
mixtures now offered. 

MERCURIALS. 

Hydrargyri Iodiddm Eubrum. — U. S. P. — 
Red Mercuric lodid or biniodid of mercury is the 
most active of all the official germicides and anti- 
septics. It is comparatively expensive, however, 
and is only slightly soluble in water. 

Hydrargyri Ciilohidum Corrosivum. — U. S. P. 
Corrosive Sublimate is by far the most popular and 
most generally used of all local chemical disinfect- 



60 PHARMACOPEIA AND PHYSICIAN. 

ants and antiseptics. It is extremely poisonous 
and many fatalities have occurred from its use, 
even in the vagina and in the vi^ashing of wounds. 

Mercuric chlorid is slowly but completely solu- 
ble in 13 parts of water and in 3 parts of alcohol. 
The solubility of this substance in water is much 
facilitated by the presence of other soluble chlorids. 
This fact has been utilized in the preparation of 
the commercial tablets of mercuric chlorid that 
are sold for making antiseptic solutions. These 
tablets usually contain about 0.5 gm. (7.5 grains) 
each of mercuric chlorid and ammonium chlorid, 
the sal alembroth of the alchemists, which, when 
dissolved in 500 c.c. (1 pint) of water make a solu- 
tion of 1 to 1,000. This solution is useful for the 
disinfection of the hands, for walls and floors and 
for many fabrics that are not injured by water. 
Gauze impregnated with a solution of mercuric 
chlorid is often placed over small or closed wounds 
to prevent the access of bacteria. It is widely used 
as an antiseptic and disinfectant, but it is ex- 
tremely caustic and can not be applied to mucous 
membranes and to open wounds except in very 
dilute solutions, for fear of absorption. 

Mercuric chlorid attacks metals and must be 
avoided, therefore, with metallic instruments. It 
is a very popular insecticide and a number of the 
mercurials are used as parasiticides, notably for 
pediculi. For this purpose, however, the various 
ointments of mercury are more frequently used. 

Unguentum Hydrargyei. — U. S. P. — Mercu- 
rial Ointment contains 50 per cent, of mercury. 

Unguentum Hydrargyei Dilutum. — U. S. P. 
— Blue Ointment, a new addition to the Pharmaco- 



LOCAL ANTLSEPTIC^. 61 

peia^ contains 33 per cent, of mercury and con- 
forms more closely to the proposed international 
standard for mercurial ointment. Another oint- 
ment that is sometimes used as a parasiticide is 

IJN^GUENTUjr Htdrakgyri Oxidi Eubki. — TJ. S. 
P. — Ointment of Eed Mercuric Oxid, or red pre- 
cipitate ointment, containing 10 per cent, of red 
mercuric oxid. 

ANTISEPSIS OF THE MUCOUS MEMBRANES. 

The antisepsis of the mouth is important, not 
only because of the infectious diseases pertaining 
to it^ but also because of the excellent opportunity 
that is afforded to micro-organisms to multiply 
there in enormous numbers on the particles, of 
food in the cavities of teeth or wedged between 
tliem. That this is true is shown by the putrid 
smell acquired by particles of meat which remain 
Init an hour or so in the mouth. The extent to 
wbich bacteria may increase may be inferred from 
the calculation, given by N"ovy, that 30,000,000,- 
000 contain less than one-sixth of a milligram 
(1/400 grain) of organic matter. 

The main factor in securing antisepsis of the 
mouth is cleanliness. If the teeth are carefully 
cleansed and all organic matter removed, the bac- 
teria have less on which to thrive, and mild anti- 
septics then fully suffice to keep the number with- 
in bounds. 

Liquor Antisepticus. — U. S. P. — Antiseptic 
Solution is a new addition to the Pharmacopeia, 
containing 2 per cent, of boric acid with aromatic 
iiiitisej)tic volatile oils. It is designed to be used 



(i2 PHARMACOPEIA AND PHYSICIAN. 

as a mildly antiseptic lotion or wash,* as are 
numerous similar proprietary preparations. 

It must be remembered that the name of this 
official antiseptic solution is a misnomer in effect, 
if not in fact, since it possesses, at most but very 
weakly antiseptic properties, being a detergent 
rather than an antiseptic. 

Antiseptic Solution is also useful as a gargle, 
preferably diluted with an equal quantity of water. 
The use of solution of hydrogen dioxid as a spray 
or gargle, as well as its use in connection with the 
official antiseptic solution, has been mentioned. 

PoTAssi Chloras. — U. S. P. — Potassium Chlor- 
ate, while not a particularly active antiseptic, has 
long been favorably known to be a desirable addi- 
tion to gargles and mouth washes. It is soluble 
in 16 parts of cold water and is generally used in 
saturated solution, from which, traces of chloric 
acid may possibly be liberated. Alum and boric 
acid are also useful as gargles. 

Free chlorin is an effective disinfectant and it 
may be utilized in the form of a gargle, being lib- 
erated by the action of hydrochloric acid on po- 

4. The official antiseptic solution is slightly acid. When 
an alkaline antiseptic month wash is desired it will be w'ell 
to nse the "Alkaline Antiseptic Solution" of the National 
Foi-mularly. Either one of these preparations can be pre- 
pared readily by any trained pharmacist. They are inex- 
pensive and should be given the preference over the various 
nostrums that are not alone exploited as local antiseptics, but 
are also advertised as sure cure remedies for a number of in- 
testinal disorders. 

LIQUOR ANTISEPTICUS ALKALINUS, N. P., represents 
3.2 parts each of potassium bicarbonate and sodium benzoate, 
0.8 parts of sodium borate in a mixture of alcohol, glycerin 
and water, flavored with thymol, eucalyptol, oil of peppermint 
and oil of gaultheria and colored red with tincture of cud- 
bear to make 100 parts. 



LOCAL ANTISEPTICS. 63 

tassium chlorate. This occurs in such a mixture as 
tlie following : 

IJ. Potassii chloratis 3iss 61 

Acidi hydrochlor 3i 4 

AquiB q. s. ad §iii 100 1 

M. Sig. : Use as a gargle. 

After the use of any of these gargles the mouth 
should he well rinsed with water to prevent injur}- 
to the teeth. 

The antisepsis of the nasal passages is usuall}' 
accomplished hy thorough cleansing with warm sa- 
line solution (0.9 per cent.), nine grams (135 
grains) of sodium chlorid to a liter (quart) of 
water, or hy a mild alkaline solution made by add- 
ing nine grams (135 grains) of sodium bicarbon- 
ate to the saline solution Just mentioned; after 
which a mildly antiseptic solution, such as the of- 
ficial properly diluted, is used as a spray or douche, 
or, in lieu of this, one-tenth of 1 per cent, of 
phenol may be added to the saline douche, but the 
latter is not recommended as a routine practice." 

It may be permissible here to enumerate some 
of the substances that have been used as mild anti- 
septic applications to the mucous membranes. 

AciDUM BoRicuM. — U. S. P. — Boric Acid, gen- 
erally referred to as boracic acid, is quite free 



."). The i)liaimafoi)pia of the German IIosi»itaI, Philadel- 
phia, (.-ontains a foi'rmila for an alkaline antiseptic tablet 
that has foiiiul favor with some. It contains 0.'17> ^m. 
(about 4 Ki-ains) each of sodium bicarbonate, sodium borate, 
sodium chlorid and sodium phenolsulpbonate with 0.005 Km. 
(about 0.1 minim) of oil of cinnamon. One of these tablets 
(the same mixture can also be directed in powder) is to be 
dissolved In sI.k tablespoonfuls of recently boiled water and 
(ised as a wa.sh for the nose. 



64 PHARMACOPEIA AND PHYSICIAN. 

from toxicity. It is soluble in about 16 parts of 
water and is but slowly absorbed. 

Glycekitum Boroglycerini. — U. S. P. — 
Glycerite of Boroglycerin, contains 30 per cent, of 
boric acid and has the same uses as that acid. 

SoDii Boras. — U. S. P. — Sodium Borate, or 
borax, has an alkaline reaction and is sometimes 
preferred to boric acid on this account. It is solu- 
ble in sixteen parts of water. 

SoDii Chloridum. — U. S. P. — Sodium Chlorid, 
common table salt, has been in use as an antiseptic 
from time immemorial; its uses are well known, 
and the only reason we have for presenting it here 
is to call attention to the fact that the Pharmaco- 
peia recognizes it as a valuable article of the ma- 
teria medica and provides certain standards and 
tests for purity. 

SoDii Phen^olsulphonas. — U. S. P. — Sodium 
Phenolsulphonate, the sodium sulphocarbolate of 
former editions of the Pharmacopeia, is another 
mild antiseptic that has limited but well-defined 
uses. 

Practically all the salts of the alkalies have anti- 
septic properties, but it is obviously not necessary 
to recount all of them at this time. 

Complete disinfection of the nose, mouth, throat, 
vagina and urethra is not practicable, and is not 
even necessary; the main thing to be sought is the 
cleansing of those regions from pus and organic 
matter on which bacteria thrive. Mucous mem- 
branes decompose the solution of hydrogen dioxid 
with such copious evolution of oxj-gen that it can 
not be used in the nose, and because of this rapid 
action by the mucous membrane itself a large 



LOCAL ANTISEPTICS. 65 

amoimt frequently repeated is necessary to com- 
pletely disinfect such cavities." 

The antisepsis of the eye is confined largely to 
the use of camphor water, boric acid and sodium 
borate. In virulent affections more active antisep- 
tics are sometimes indicated; in these cases weak 
solutions of mercuric chlorid, copper sulphate, zinc 
chlorid, silver nitrate or formaldehyd are used. 
These substances, however, are all extremely irri- 
tating and great caution is required. Their use 
by the general practitioner is not advised.^ 



6. For use in the vagina, where a simple detergent and 
antiseptic action is sought, the official Liquor Cresolis Com- 
positus in 0.5 to 1 per cent, solution will be found to be all 
that is required. When an astringent effect is desired the 
following formula for an antiseptic astringent powder will be 
found to answer the purpose very well : 

R. Sodii boratis Si 601 

Alumin. exsicc ox 40 1 

Thymol, I 

Phenol, 

Eucalyptol, 

Olel gaultherise, fia gr. viii |5 

M. SIg. : A heaping teaspoonful to be dissolved in one 
liter (1 quart) of hot water, to be used as a douche. 

Pulvis Antisepticns. N. P., contains 12.5 parts of zinc 

sulphate, 86.6 parts of boric acid. 0.5 part of salicylic acid 

and 0.1 part, each, of phenol, eucalyptol, menthol and thymol. 

It may be used in the same way and for the same purposes 

as the prescription given above. 

Tyree's Antiseptic Powder formerly had a considerable 
vogue among physicians ; since the exposure of its true char- 
acter by The Journal of the American Medical Association 
(Oct. 20, 1906, p. 1316), it Is to be hoped that physicians 
will depend on it less than they did. 

Campho-phenique Powder affords another example of ex- 
traordinary discrepancy between the formula claimed by 
the manufacturer and the composition shown by analysis. 
See Thk .TounxAL A. M. A., April 20, 1007, p. 1365. 

7. The method of using boric acid in the eye varies 
greally, but usually a 2 per cent, solution of boric acid in 
equal parts of distilled wafer and camphor water will be 
found to be snfflcient. When it is desired to use sodium 
borate In connection with boric acid the following will be 
found satisfactory' : 

R. Acid! borlcl gr. xv 1 

Sodii boratis gr. xxx 2 

Aqua; dest.. 
AqujE campborii'. fia ,?iss 50 



66 PHARMACOPEIA AND PHYSICIAN. 

Burns or scalds resulting in. destruction of the 
skin should be treated antiseptically. Treves di- 
rects that the burn be washed with a solution of 
hydrogen dioxid and then with a .solution of boric 
acid; the vesicles are then opened with an aseptic 
needle and the surface dusted with iodoform and 
dressed with aseptic cotton. 

PoTAssii Permanganas. — U. S. P. — Potassium 
Permanganate, already referred to under the head 
of general disinfectants, is often considered to be 
devoid of antiseptic properties because of the readi- 
ness with which it oxidizes all organic matter. It 
is true that potassium permanganate is readily de- 
composed by the organic matter with which it first 
comes in contact, and that it would be unusual in- 
deed to find bacteria the only form of organic mat- 
ter present in any one case. When we remember, 
however, that a very large number of bacteria 
represent but an infinitesimally small amount of 
organic matter, we will appreciate why potassium 
permanganate is capable of destroying vast num- 
bers of micro-organisms in those cases in which 
its action can be confined to them. 

This substance finds its greatest usefulness as a 
local apjDlication in rendering foul ulcers odorless. 
For this purpose a fairly strong solution, 2 per 
cent., is freely used as a wash. Much weaker solu- 
tions are sometimes used with great benefit as 
urethral irrigations in gonorrhea and as vaginal 
douches. A hot 1 per cent, solution of potassium 
permanganate will be found extremely useful as a 
deodorizer for instruments after use in the vagina 
while awaiting sterilization. 



LOCAL ANTISEPTICS. 67 

Potassium permanganate destroys some alkaloids 
miicli more quickly than others, e. g., morphin 
more readily than strychnin. It can not enter the 
circulation ; hence, when swallowed, it can act only 
on the substances found in the stomach. Obvious- 
ly it is not suited for hypodermic injections. 



CHAPTER III. 
INTERNAL ANTISEPTICS. 

The great strides made in the use of antisep- 
tics, after Lister had employed them in surgery 
with such brilliant results, led to the hope that 
they might be made available for limiting the de- 
velopment of bacteria in various parts of the hu- 
man body. From time to time clinicians have re- 
ported favorable results from the use of internal 
antiseptics in such diseases as typhoid fever, but- 
at the present time it is generally acknowledged 
that complete disinfection of the intestinal tract is 
impossible and that the treatment of constitutional 
diseases by means of antiseptics is possible only in 
a few isolated cases; for example, in malarial 
fever by quinin, in articular rheumatism by sali- 
cylic acid and its compounds, and in syphilis by 
means of mercurials. Quinin has been shown to 
have a peculiarly selective and destructive action 
on the protozoon which causes malarial fever, and 
perhaps mercury and salicylic acid may possess 
similar selective action against the agents produc- 
ing syphilis and certain forms of rheumatism. 

It is not probable that any agent will be found 
which will protect the blood and tissues against 
many species of bacteria, but we may discover 
substances, each with a specific action analogous to 
that of quinin in malaria. The discussion of in- 
ternal antiseptics will be limited, therefore, to the 
substances just mentioned — quinin, mercury and 



INTERNAL ANTISEPTICS. 69 

salicylic acid — and substances used as antiseptics 
in the alimentary canal. 

It is impossible to form a correct idea of the 
probable effect of an internal antiseptic without 
having at least some idea of the organisms on 
which, it must act. 

Nuttall and Thierfelder took guinea-pigs from 
their mother by Cesarean section under aseptic 
conditions, and fed one of them on sterilized food 
for thirteen days, during which it continued to 
thrive, but Schotelius found that chickens died of 
starvation when fed only on sterilized food. G. 
X. Stewart accepts Nuttall and Thierf elder's re- 
sults as demonstrating that animals, including 
man, exist, despite the bacteria which infest the 
alimentary canal from a few hours after birth until 
death. 

Strassburger concludes, from a review of the 
extensive literature pertaining to intestinal bac- 
teria, that Nuttall and Thierfelder have shown 
that no single process of alimentation is absolutely 
dependent on bacteria, but that the chief function 
of certain of them, notably the colon bacillus, 
which is always abundantly present, is actually to 
destroy other bacteria and thus to protect the host 
against those disease germs which, may gain en- 
trance to the alimentary canal. The destruction 
of all the bacteria in the alimentary canal at any 
one time, therefore, might prove fatal, in that any 
disease germs which chanced to gain access to the 
intestine could so multiply as quickly to destroy the 
life of the host. 

The proof that Ijacteria do play some part in the 
process of digestion is found in the fact that man 



70 PHARMACOPEIA AND PHYSICIAN. 

can digest the cellulose of delicate vegetables to a 
limited extent, though he secretes no enzyme cap- 
able of splitting cellulose, which, therefore, must 
be split by bacteria present which have been shown 
to possess that power. Then, too, certain crj^stal- 
line bodies other than leucin and tyrosin have re- 
cently been found among the ultimate products of 
digestion, and as none of the known digestive 
enzymes are capable of forming these bodies they 
likewise must result from bacterial action. 

While we must admit that bacteria are concerned 
in digestion, we have no positive information at the 
present time as to how important a part they ac- 
tually take. It has been shown that the colon ba- 
cillus, which is universally present in milk, inhib- 
its, to a certain extent, the action of putrefactive 
bacteria, and it is well known that untreated milk 
of good quality is more digestible than is the same 
milk after sterilization.^ 

1. Tests made on the several constituents of milk show 
that they have no power to inhibit putrefaction, though 
such a power is unquestionably possessed by fresh milk. 
That this is due, at least in part, to certain bacteria nor- 
mally present in the milk is shown by the fact that sterilized 
milk putrefies much more rapidly than untreated milk on 
the addition of the bacillus of putrefaction (B. piitriflcus) : 
but if with the Bacillus putrificiis the colon bacillus be 
added to sterilized milk, the milk acts as does normal milk, 
thus proving that the colon bacillus is actually capable of 
inhibiting the development of certain bacteria. It is. of 
course, possible that fresh milk also possesses antibacterial 
properties which are destroyed by the sterilization. These 
conditions help to explain why sterilized milk Is not so 
wholesome as new milk of good quality. It must be remem- 
bered, however, that milk is an excellent culture medium in 
which a great many bacteria are normally present, and that 
if it be allowed to stand in a warm place for some hours 
the micro-organisms multiply to such an extent that the 
milk is wholly unfit for use, and we do not wish to be mis- 
understood as implying that the colon bacillus is an un- 
mixed blessing. Whilst during health the micro-organism 
probably does not emigrate from the uninjured intestine it 
may do so in states of lowered general resistance, or in the 



IXTERNAL AyTISEPTIGS. 71 

We are thus forced, by this and other like evi- 
dence, to conclude that it is by no means desirable 
to render the intestines sterile and that, instead of 
attempting intestinal antisepsis in the broader 
sense, we should seek rather to modify the flora in 
that region than to destroy it. 

Various methods have been proposed, from time 
to time, for determining the relative degree of 
putrefaction taking place in the intestines, but at 
the present time it is not positively known what 
constitutes the best method at our disposal for 
doing this. The procedure most frequently em- 
ployed, one which is considered to afford a fair es- 
timate in a large proportion of cases, consists in 
estimating the ethereal sulphates in the urine. 
Strasslnirger claims that weigliing the bacteria after 
separation from the feces and drying affords the 
surest means of estimating the number of bacteria 
present. Others count the number of colonies 
which can be cultivated from a milligram of feces, 
but this has been shown to be unreliable. In view 
of the fact that laboratory methods are far from 
satisfactory in determining the number of the sev- 
eral varieties of bacteria present in the feces, the 
general practitioner will probably be obliged, for 
some time to come, to depend largely, if not en- 
tirely, on the clinical data presented by each in- 
dividual case. 

prpsenre of defects of the intestinal epithelium, and mav s've 
rls<? to blood infection, or more rarely to inflammations in 
various organs. The possibility that the bacillus of typhoid 
fever and kindred forms are only modified colon bacilli is 
of theoretical importance. Some authorities (Escherich and 
some others) deny that the colon bacillus is capable of rap- 
Idly becoming virulent. DllTerent strains of the colon bacil- 
lus have different degrees of virulence, and it still remains 
possible that many cases of infantile colitis are caused by 
certain strains (f. p., the colicolltls of Escherich). 



72 PHARMACOPEIA AND PHYSICIAN. 

Without knowing the precise role played by the 
raultitudinons bacteria of many species, we do 
know in various ways when undue activity of the 
putrefactive bacteria occurs and certain symptoms 
give notice that excessive fermentation is taking 
place in the small intestine. A moderate increase 
in the number of colon bacilli tends to lessen the 
development of the putrefactive germs; on the 
other hand, an intestinal catarrh, caused by exces- 
sive acidity resulting from the undue fermenta- 
tion of carbohydrates by the colon bacillus, may be 
alleviated by lessening the carbohydrates of the 
food and consequently the medium on which the 
colon bacillus thrives. 

Normal peristalsis prevents undue development 
of bacteria by hurrying the food through the small 
intestine, but diarrhea and irritant purgatives 
favor the development of bacteria by the increased 
amount of liquid which is present, because of the 
increased secretion and diminished absorption. 
Thus more bacteria have been found after admin- 
istration of calomel than were present before the 
drug had been given, though calomel is generally 
considered to be an excellent antiseptic. 

While normal peristalsis limits the develop- 
ment of bacteria, the latter, in turn, liberate acids 
in the decomposition of carbohydrates which prob- 
ably supply the stimulus which sets up peristalsis. 
The normal digestion and absorption of food also 
tend to lessen intestinal putrefaction by lessening 
the amount of material which can serve as a cul- 
ture medium. 

It is important that the intestinal wall should 
be kept intact. When the intestinal mucosa is in- 



INTERNAL ANTISEPTICS. 73 

jured it fails to absorb the food products and the 
bacteria multiply rapidly. It has been found that 
many antiseptics injure the intestinal wall more 
than they do the bacteria, and, despite the fact that 
the antiseptic may be found in quantity in the 
feces when the bulk is small, it has actually per- 
mitted an increased growth of micro-organisms in 
the small intestine when other conditions favored 
the bacteria and not the antiseptic action. Srass- 
burger found just double the number of bacteria 
after the use of naphthalene, which has been con- 
siderably lauded as an intestinal antiseptic. 

As suggested before, the simplest means of di- 
minishing the number of putrefactive bacteria is 
by lessening the amount of the proteid of the food. 
Though it has been contradicted by the indirect 
evidence of urinary constituents, it has been shown 
that the bacteria of the intestines are very much 
reduced in number by the withdrawal of all food. 

It was formerly supposed that the gastric juice 
of the stomach interposed a fairly effective barrier 
to the entrance of living disease germs into the in- 
testine, but this juice has but little effect at the be- 
ginning of digestion, when the activity is slight, 
and toward the end, when the hydrochloric acid is 
nearly all combined with proteid. Some micro- 
organisms, e. g., the tubercle bacillus, pass unin- 
jured through the stomach more readily than otli- 
crs, e. g., the vibrio of cholera. 

The effect of bile on bacteria is not })o.silivoly 
known, but it is generally supposed that it does not 
possess any germicidal power, as some bacteria can 
be cultivated on bile, though not after the precipi- 
tation and removal of the mucus. The intestinal 



74 PHARMACOPEIA AND PHYSICIAN. 

secretion does not possess any germicidal power. 
All these factors are important, since all of them — 
bile, gastric juice and intestinal secretion — have at 
various times been supposed to possess antiseptic 
properties, and it is necessary to know what results 
are to be expected from increasing the quantity of 
any or all of them. 

Strictly speaking, the antisepsis of the alimen- 
tary canal should begin with that of the mouth, 
but this is more conveniently considered under 
local antisepsis. In view of the fact that the gas- 
tric juice does not interpose an absolute barrier to 
the ingress of pathogenic bacteria to the intestine, 
the proper care of the mouth and the limitation of 
its flora assumes an added importance, and there is 
no question of the fact that proper attention to the 
cleanliness of the oral cavity will greatly lessen the 
danger from intestinal infection. 

The general tone of these varied statements may 
appear pessimistic, so far as faith in the efficiency 
of intestinal antisepsis is concerned, but so far 
from that being the case they are intended to fur- 
ther demonstrate that our main reliance must, after 
all, be placed in guarding against the entry of 
disease-producing organisms into the alimentary 
canal and their destruction before they have passed 
beyond the reach of local treatment. After they 
have once gained admittance to the intestine the 
best means of limiting their development must be 
sought in regulating the diet and careful attention 
to the general condition. 

If we are unable to destroy all or even any 
appreciable number of the bacteria of the intestine, 
it is consoling to loiow that some of them are our 



INTERXAL ANTISEPTICS. 75 

allies instead of our foes. It is admitted by nearly 
all authorities that it is impossible to influence the 
bacillus of typhoid fever by antiseptics. It has 
been sho^\Ti that a milk diet sometimes hinders the 
development of putrefactive bacteria, and many 
consider that the main benefit derived from a milk 
diet in tj-phoid fever is due to its effect on bacterial 
development. Fortunately, the Bacillus typhosus 
does not form spores and the bacillus itself is easily 
killed outside of the body; heating in water even 
to 75 C. (167 F.) for ten minutes greatly lessens 
its vitality. 

It is practically impossible in the space at our 
disposal even to summarize the results of the hun- 
dreds of investigations dealing with the question of 
intestinal antisepsis. Those experiments which ap- 
pear more nearly free from error point to the fact 
that we can not secure direct antiseptic action by 
chemical antiseptics in the intestine without injur- 
ing the intestinal wall, or at least materially reduc- 
ing those conditions which naturally limit bacter- 
ial development; more than we injure the bacteria. 
The net result, therefore, is usually an actual in- 
crease of some species and a diminution of others. 
Clinical experience seems to prove conclusively that 
the mild mercurous chlorid, or calomel, is bene- 
ficial in those cases of indigestion which are char- 
acterized by that train of symptoms which include? 
a feeling of dulness, lassitude, headache, nausea 
and anorexia, the condition being popularly termed 
"biliousness." It is possible that tlie antiseptic ac- 
tion of the calomel, by limiting the development of 
other species of bacteria, gives the colon bacilhis 
a chance to multiply, the increased amount of fluid 



76 PHARMACOPEIA AND PHYSICIAN. 

ill the intestine having been found particularly to 
favor its development. These, in turn, may then 
modify digestion or serve to restrict the develop- 
ment of putrefactive bacteria, and, as we have seen, 
they favorably influence peristalsis, which in turn 
is one of the natural means of elimination of bac- 
teria. The increased peristalsis caused by the cal- 
omel lessens the opportunity for absorption of the 
bacterial toxins which give rise to the train of 
symptoms mentioned ; this lessened absorption may 
Ije due in part to the action of calomel on the wall 
of the intestine. This merely suggests the many- 
sidedness of an operation that appears at first 
glance to be a very simple one. 

The action of the solution of hydrogen dioxid 
in the mouth and throat has been discussed under 
local antiseptics. Owing to the rapidity with which 
it is decomposed by mucous membranes, it can 
exert but little germicidal action in the stomach 
and absolutely none in the intestine or general 
circulation; indeed, it is so rapidly decomposed 
by the blood that it speedily causes death by em- 
bolism when introduced into the circulation. The 
same holds true of potassium permanganate, and 
it is probable that all antiseptics that depend for 
their action on the liberation of oxygen would be 
decomposed in the same way when brought in con- 
tact with the mucous membranes of the mouth and 
throat or the organic material necessarily present 
in the stomach. 

AciDUM Hydrochloricum.— U. S. P. — Hydro- 
chloric Acid, or muriatic acid, contains 31.9 per 
cent, of absolute hydrochloric acid. It is seldom 
used in medicine in this country, the preference 
being usually given to 



IXTERXAL ANTISEPTICS. 77 

ACIDUM HYDEOCHLORTCmr DiLUTUM. — U. S. P. 

— Diluted Hydrochloric Acid, containing 10 per 
cent, of absolute hydrochloric acid. This acid un- 
doubtedly exerts some germicidal action in the 
stomach when present in sufficient amount, and its 
action may directly influence the intestinal flora. 
It has been stated that the hydrochloric acid of the 
stomach becomes bound to albumin during diges- 
tion and then exerts no antiseptic influence, but we 
have also seen that normal digestion is one of the 
surest means of controlling the bacteria of the in- 
testine, and how a deficiency of that acid may cause 
fermentative dyspepsia, with an enormous increase 
of bacteria, which may become virulent. It may 
be mentioned in this connection that, according 
to some recent experiments on man, the usual dose 
of dilute hydrochloric acid, 1 c.c. (15 minims) is 
entirely too small to supply the deficiency existing 
in many cases, and as much as 200 c.c. (6 fluid 
ounces) of 0.4 per cent, acid, corresponding to 10 
c.c. of the official dilute acid, has been given with 
decided benefit when the usual dose or less had 
given no appreciable result. It must always be 
given diluted with a large amount of water. It 
should be remembered that mineral acids are to be 
taken through a tube to avoid injury to the teeth, 
and that the mouth should then be rinsed with 
water, or, better still, with a mild alkaline solu- 
tion, such as limewater or a very dilute solution 
of sodium bicarbonate. 

\ Ai'iiTiiALENU.Ar. — U. S. P. — Naplithalene, 
naphlalin and 

RETAJTAPirTiiOL. — TJ. S. P. — Bctanaphthol 
and nnphthol liavc ])ocn liiglily rccotrimondod as in- 



7S PHARMACOPEtA AND PHYSICIAN. 

testinal antiseptics. As we have seen, they do not 
usually lessen the number of bacteria, though they 
may exert a favorable, modifying action. These 
substances have been used in the treatment of diar- 
rhea with excessive putrefaction. They are insolu- 
ble in water and are preferably directed to be dis- 
pensed in powder form, or dry, in capsules. ^ 

The average dose of naphthalene is given as 
0.13 gm. (2 grains), and the average dose of beta- 
naphthol as 0.25 gm. (4 grains). It has been sug- 
gested that naphthalene must be converted mto 
betanaphthol before it can exert its antiseptic ac- 
tion, but even this point has not been satisfactorily 
determined. 

There are a number of nostrums on the market 
consisting of betanaphthol combined with astring- 
ents, but in view of the complex nature of the prob- 
lem with which we have here to deal it is preferable 
by far to employ the official substances, combining 
them as seems indicated in each case. To do this 
it is merely necessary to calculate the relative 
amount of each powder to be given at a dose and 
to dispense them either separately or in a single 
powder or a mixture. 

Betanaphthol and bismuth subnitrate or subcar- 
bonate may be combined somewhat as follows: 

IJ. Bismuthi subnitratis 3i 41 

Betanaphthol gv- xv 1 1 

To be made into ten powders, one being given every 
two hours for diarrhea with foul-smelling feces. 

IJ. Bismuthi subnitratis 3iiss 10 

Betanaphthol 3ss 2 

Syrupi acacise Biss 50 

Aqu£e camphor* to make 5iii 100 

One teaspoonful to be given, after shaking, every two 
hours. 



INTERNAL ANTISEPTICS. 79 

The number and variety of substances that have 
been suggested from time to time as intestinal an- 
tiseptics justifies a more extended review, but we 
can do little more than enumerate some of tho 
official substances that have been used in the treat- 
ment of the several gastrointestinal disorders.- 

Though it is impossible to secure asepsis of the 
intestinal tract by chemic means, lavage of the 
colon removes feces and vast numbers of bacteria 
which swarm in that region. Lavage is now pur- 
sued as a routine measure in diarrhea and dj-sen- 
tery. Proper attention must be paid to the technic 
of the operation, particularly with infants and 
small children, as serious harm may result from 
inattention to details, more especially in the mat- 
ter of the temperature of the liquid and the pres- 
sure at which it is injected. 

Normal saline or solution of boric acid is com- 
monly used for the purpose ; to this, opium may be 
added with caution in suitable cases, for instance, 
where there is much tenesmus. 

The use of antiseptics in the treatment of 
typhoid and typhus fevers was first suggested in 
Germany more than thirty years ago, and the argu- 
ments that were offered at that time appeared so 
plausible that internal antiseptics at once sprang 
into vogue. Among the more popular were the 
following : 

loDUM. — U. S. P. — lodin is very seldom used as 
such at the present time. 

2. The following lias beon used to a considerable extent 
In the treatment of K^strlc fermentative dyspepsia, partic- 
ularly when afcompanlf?d by nervous disturbances: 

IJ.' Sodii bromidi gr. v 13 

Itcsorcinol f;r. il 1 

Aquse anlsl q. s. ad 311 10| 

Tills dose to be talien after meals in half a glass of water. 



80 PHARMACOPEIA AND PHYSICIAN. 

Average close: 0.005 gm. (5 mg., 1/10 grain). 

Liquor Iodi Compositus. — U.S. P. — Compound 
Solution of lodin, better known as Lugol's solution, 
contains about 5 per cent, of iodin and 10 per cent, 
of potassium iodid in distilled water. This was at 
one time a favorite method of administering iodin. 

Average dose: 0.8 c.c. (3 minims). 

TiNCTURA Iodi. — U. S. P. — Tincture of Iodin is 
vdrutually a new preparation and combines the 
strength of the former official tincture with the 
water-soluble properties of the unofficial compound 
tinctures, or soluble iodin solutions. It contains 7 
per cent, of iodin and 5 per cent, of potassium 
iodid in alcohol. This combination appears to con- 
duce to stability and also permits of dilution with 
water, without precipitation. 

Average dose: 0.1 c.c. (ll^ minims). 

Iodin and the water-soluble preparations of iodin 
were formerly much lauded as intestinal antisep- 
tics, and even at the present time, though, as was 
shown in the introductory portion of this article, 
the practice is now obsolete, they are frequently 
exploited by manufacturers of nostrums as being 
little short of the ideal. The form in which iodin 
was formerly largely used was in connection with 
carbolic acid or phenol, thus : 

U. Tinct. iodi 3iiss 101 

Phenol m. Ixxv 5| 

M. Sig. : 1/2 to 11/2 minim three times a day in water. 

PhenoP itself is now seldom employed, or even 

3. The Plienol-sodique of Hance Brothers & White must 
not be confounded with that of the National Formulary, 
which possesses approximately one hundred times the phenol 
content of the nostrum. The false statements concerning 
their preparation made by that firm have been exposed in 
THE Journal of Nov. 9, 1907, p. 1617. It is practically 
worthless for disinfectant purposes. 



INTERNAL ANTISEPTICS. 81 

recommended, as an intestinal antiseptic, but the 
official phenol sulphonates, better known as sulpho- 
carbolates, still have a number of ardent advocates. 

SoDii Phentolsulphoxas.— U. S. P. — Sodium 
Phenolsulphonate, the sodium sulphocarbolate of 
the previous Pharmacopeia. 

Average dose 0.25 gni. (4 grains). 

ZiNCi PhexoLvSULphoxas. — U. S. P. — Zinc 
Phenolsulphonate is rather more active than the 
sodium salt, combining the astringent properties 
of the zinc with the antiseptic properties of the 
phenolsulphonic acid. 

Average dose 0.12 gm. (2 grains). 

Both the official salts are readily soluble in water 
and may be given in solution. Calcium phenol- 
sulphonate is being lauded by some as an intestinal 
antiseptic, but there is no reason to believe that it 
offers any advantages over the sodium salt, and it 
is probably quite as harmless. 

The following official derivatives, or substances 
coming directly under the same classification as 
phenol, are all comparatively insoluble in water 
and, for internal use, should be dispensed in cap- 
sules or in the form of emulsions or mixtures that 
are directed to be well shaken : 

Thymol.— U. S. P. 

Average dose: 0.12 gm. (2 grains). 

Creosotum. — U. S. P. 

Average dose 0.2 c.c. (3 minims). 

GUAIACOL.— U. S. p. 

Average dose: 0.5 c.c. (8 minims). 
GuAiAcoLis Carbon AS. — U. S. P. 
Average dose: 1 gm. (15 grains). 
AciDDM Salicylicum. — TJ. S. P. 
Average dose: 0.50 gm. (7l^ grains). 



82 PHARMACOPEIA AND PHYSICIAN. 

Phenylis Salicylas.— U. S. P.— Phenyl Sali- 
cylate, better known by its former official title, 
salol, is even now considered as being among the 
few really desirable or available internal antisep- 
tics. It occurs as a white crystalline powder, hav- 
ing a faint but characteristic odor and a slight, 
rather peculiar taste ; it is only slightly soluble in 
water, and, therefore, does not dissolve to any ap- 
preciable extent in the juices of the stomach. It is 
decomposed, however, by the alkaline liquids of the 
intestine into its constituents, phenol and salicylic 
acid, and thus becomes available as an antiseptic. 
It is said to be particularly useful in preventing 
the infection of the kidneys by the Bacillus ty- 
pliosus. 

Average dose: 0.50 gm. {n/2 grains). 
HEXAMETHYLENAMmA.— U. S. P.— Hexametli- 
ylentetramin will be discussed at greater length 
under diuretics (Chapter XVI). This substance 
has also been recommended as an available intes- 
tinal antiseptic, but, as noted under diuretics, the 
ultimate products of its decomposition are largely, 
if not entirely, eliminated by the kidneys, and it no 
doubt finds its greatest field of usefulness in pre- 
venting possible infection of the urinary organs. 
Average dose: 0.25 gm. (4 grains). 
It is manifestlv impossible to discuss or even to 
mention all the agents that have been, or are, em- 
ployed as intestinal antiseptics. Many of the reme- 
dies that are recommended as intestinal antisep- 
tics are also useful as anthelmintics. Notable 
among these is thymol, which has been referred to 
frequently of late as being an efficient anthelmm- 
tic. 



INTERNAL ANTISEPTICS. 83 

Though many efforts have been made to treat 
tuberculosis by means of internal antiseptics, the 
favorable influence which has so far been observed 
is to be attributed to the beneficial effects produced 
on the tissues, and not to any direct bactericidal 
action produced by the antiseptics themselves. Of 
the remedies that have been suggested for this pur- 
pose, creosote and guaiacol continue to be used, 
probably with some benefit. 

The whole problem, however, appears to concern 
curative effect and treatment rather than antisep- 
sis. 

Few articles in our materia medica possess any 
action so specific as that shown by cinchona or its 
chief alkaloid, quinin, in the treatment of certain 
forms of malarial fever. Cinchona bark itself 
owes its introduction into Europe to the fact that 
it was found to be efficient in the treatment of 
fevers of a malarial type. For many years after its 
introduction into Spain the Jesuits had the bark 
sent to them by their brethren in Peru and care- 
fully kept the source of its origin a secret, and the 
substance, therefore, became widely known as Je- 
suits' bark. Being virtually introduced as a nos- 
trum, or secret remedy, it need not surprise us 
when we find that it has frequently taken a most 
important part as one of the component parts of a 
variety of nostrums, even down to our own times. 

Quinin, the most valuable of the alkaloids of cin- 
chona, was discovered by Pelletier and Cavcntou in 
1820, and is to-day one of the few substances in 
medicine that has met with a constantly increas- 
ing popularity. Quinin is official under no less 
than six different titles, in addition to the several 



S4 PHARMACOPEIA AND PHYSICIAN. 

scale salts and preparations that are not of direct 
interest in connection with its peculiar use in ma- 
larial fever, but which will be mentioned under the 
subject of bitters. 

QuiNiNA. — U. S. P. — Quinin. 
QuiNHsr^ BisuLPHAS. — U. S. P. — Quinin bisul- 
phate. 

QuiNiNiE Htdrobromidum. — U. S. P. — Quinin 
hvdrobromid. 

QuixiN^E Hydrochloridum. — IT. S. p. — Qui- 
nin hydrochlorid. 

QuiNiN.E Salicylas. — U. S. P.— Quinin salicy- 
late. 

QuiNix.^ Sulphas.— U. S. P.— Quinin sul- 
phate. 

Average dose of any of these preparations : 0.25 
gm. (4 grains). 

The physical properties of the several salts of 
quinin are so well known that they do not require 
a description at this time. The reasons for the 
popularity and use of some of these salts are not 
always apparent. In America the sulphate is used 
almost exclusively, while on the continent of 
Europe the hydrochlorid appears to be given the 
preference in nearly all cases. That each of the 
several official preparations of quinin has some par- 
ticular point of merit is suggested by the follow- 
ing table, showing the relative percentage of anhy- 
drous alkaloid quinin in each and also the relative 
solubilitv in water and in alcohol : 

Per cent, of Solubility Solubility 

anhvdrous quinin. in water. in alcohol. 

Quinin ^ • 85.5 1750._ 0.6 

(Quinin bisulphate.. 59.5 8.5 18. 

Quinin hvdrobromid. 76.6 40. 0.7 

Quinin liVdrochlorid. 81.5 18. U.b 

Quinin salicylate... 69.9 77. 11. 

Quinin sulphate.... 74.3 720. 8b. 



INTERNAL ANTISEPTICS. 85 

It will be noted that the very commonly used 
sulphate, next to the alkaloid itself, is the least 
soluble in water. This, while a decided advantage 
so far as masking the taste of the salt is concerned, 
is a marked disadvantage in attempting to make a 
solution of the salt. Where quinin sulphate is to 
be given in solution it must be given in an acid 
mixture or in solutions that are so dilute that the 
quantity to be taken would be nauseating.* 

The more satisfactory method of administering 
quinin in the comparatively large quantities that 
are usually given is in cachets, gelatin capsules or 
pills. 

The use of quinin as a destroyer of the proto- 
zoon which causes malarial fever is among the best 
established facts of therapeutics. It is mentioned 
here largely to avoid the criticism of incomplete- 
ness rather than to offer any suggestions of nov- 
elty to the general practitioner. 

If fairly large doses of quinin be given four 
hours before the time at which the chill of malarial 

4. It is truly surprising tliat tlie sulpliate of quinin con- 
tinues to be used almost to the exclusion of the alkaloids and 
the other salts. When a tasteless mixture is desired the alka- 
loid is preferable because it is less soluble than any of the 
official salts ; if it is necessary to administer the drug in 
solution ten grains of the hydrochlorid may be given in a 
teaspoonful of a mixture containing 50 per cent, of alcohol, 
while three grains of the hydrochlorid, or seven of the bi- 
sulphate may be given in a teaspoonful of a watery mixture. 
'I'he following is a type of the usual acid mixture : 

R. (iuin. sulphatis grs. Ixxv .')| 

Acid hydrochlorid dil m. Ixxv .T 

Kllx. aromat. q. s Jiii 10()| 

WliOTi the salt, or better, the alkaloid, is to be given in a 
mixture, and the taste is to be masked, acids should never 
be added. Instead of the acid, a sweet substance, like gly- 
cyrrhlzln, should be used to mask the bitter taste of the 
quinin. A satisfactory mixture Is obtained as follows : 
R. (inlnlnro vel quinina> sulphatis.. grs. Ixxv .')) 

Fluid oxt. glvcvrrbl/.ii" .3lv 15 

Syrn|)l .■t .■Ilx. aromat. aa q. s 3111 lOO] 



so PHARMACOPEIA AND PHY8ICfAN. 

fever is expected to occur, and the dose repeated in 
two hours, the maximum effect of the quinin on 
the organism is obtained and the chill is usually 
prevented. The quinin existing in the blood at the 
time that sporulation occurs destroys the newly 
liberated organisms and the blood is rendered asep- 
tic so far as that particular organism is concerned. 
This process has to be repeated at intervals, some- 
times for three or four weeks. 

Salicylic acid is closely related, chemically and 
pharmacologically, to phenol. Salicjdates of the 
alkalis are decomposed in the stomach and sali- 
cylic acid is liberated. 

Salicylic acid is very slightly volatile; hence it 
does not penetrate so readily as phenol, and that 
property, non-volatility, explains its more lasting 
antiseptic action. It is much more potent than 
phenol in preventing the action of enzymes. It is 
irritant to mucous surfaces, often inducing nausea, 
but it is not nearly so caustic as phenol. Strong 
solutions applied to the skin cause the destruction 
of tissue^ as in the case of warts and corns. 

The salicylates are practically valueless as 
ehologogues, though they may have some slight 
effect on the production of bile. 

Salicylic acid and the salicjdates cause increased 
metabolism and increased production of heat, but 
they also cause increased blood pressure and dila- 
tation of the cutaneous vessels. The result of these 
two actions taken together is a greatly increased 
cutaneous circulation, with increased loss of heat 
and consequent fall in the temperature. This ef- 
fect on the peripheral vessels may also explain the 



IXTERNAL ANTISEPTICS. 87 

rash sometimes observed after the use of the sali- 
cylates. 

Salicylic acid circulates in the blood as sodium 
salicylate. This in sufficient concentration is an 
antiseptic, but the salt passes too rapidly from the 
intestine to permit of its acting beneficially there, 
and it is excreted from the blood so rapidly that it 
is never in sufficient concentration to possess any 
antiseptic action. The salic3dates pass into nearly 
all the secretions of the body and are particularly 
abundant in the urine as salicjduric acid. 

Gaglio explains the action of the salicylates in 
rheumatism by the rapid excretion into the joints 
by the s3Tiovial membrane by which the salt is se- 
creted from the blood. 

Salol, or phenjd salicylate, is much less soluble 
in water than is sodium salic3date. It is decom- 
posed in the stomach very slowly, but much more 
rapidly in the intestine, with the liberation of 
phenol and salicylic acid. Owing to the slight 
solubility of salol in the stomach, it may be used 
to coat capsules of sodium salicylate which will 
then pass into the intestine without causing gastric 
disturbance. The liberated phenol exerts its ac- 
tion, and it may give rise to toxic symptoms if too 
hirge a dose of salol has been used. 

Salicin is converted in part into salicylic acid 
when taken internally, but much of it escapes de- 
struction and is excreted in tlie urine unchanged. 

ACIDUM SalicylicuiM. — U. S. P. 

Average dose 0.5 gm. ,{7^2 grains). 

SoDii Salicylas. — U. S. P. 

Average dose: 1 gm. (15 grains). 

Ammoxii Salicylas. — U. S. P. 



88 PHARMACOPEIA AND PHYSICIAN. 

Average dose: 0.25 gm. (4 grains). 

LiTHTi Salicylas. — U. S. P. 

Average dose: 1 gm. (15 grains). 

Strontii Salicylas. — U. S. P. 

Average dose: 1 gm. (15 grains). 

Phbnylis Salicylas.— U. S. P.— Salol (U. S. 
P., 1890). 

Average dose: 0.5 gm. (7% grains). 

Methylts Salicylas. — U. S. P. 

Average dose: 1 c.c. (15 minims). 

Oleum Betul.t:. — U. S. P. 

Average dose: 1 c.c. (15 minims). 

Oleum Gaultheri^. — U. S. P. 

Average dose: 1 c.c. (15 minims). 

Salicinum.— IT. S. P. 

Average dose: 1 gm. (15 grains). 

The salicylates of ammonium, sodium lithium 
and strontium may be dispensed in solution, but 
the other salicylates and salicylic acid itself are 
best dispensed in capsules. 

The salicylates were employed at one time as 
antipyretics, and they have also been used in place 
of quinin in malaria, but they have no curative 
value in that disease and are not so employed at 
present, having been superseded by less dangerous 
antipyretics. 

In acute articular rheumatism the salicylates 
enjoy a reputation akin to that of quinin in ma- 
laria. As previously stated, they are excreted into 
the urine, and, as they exert their irritant action 
on the kidneys, they must be used only with great 
caution when renal inflammation exists, as they 
are capable of giving rise to the gravest symptoms. 
Whether the salicvlates should be used when car- 



IXTERXAL AXTI8EPTWS. 89 

diac symfjtoms arise is an unsettled question. They 
should certainly be used only with caution in such 
an event. Any of the salicylates may be used, 
but the sodium salt is much the most popular. 
Large doses are often necessary in the beginning 
of treatment, but these must be diminished as the 
symptoms of the disease abate. 

Sodium salicylate may be prescribed as follows: 

I^. Sodii salicylatis Siiss 10| 

Ft. eapsulae No. xx. 

Sig. : Two capsules every three hours. 

It may be prescribed in liquid form somewhat 
as follows : 

IJ. Sodii salicylatis Siiss 10| 

Syrupi aurantii flgiss 50 

Aqua;, q. s. ad fl^iii ^OO] 

Misee. Sig.: Two teaspoonfuls every three hours. 

Such doses are too large for continued use, and 
are to be regulated according to the needs of the 
case. 

The capsules may be coated with salol after the 
manner described on page 87 to prevent gastric 
disturl)ance. The oil of wintergreen or oil of 
sweet birch is sometimes borne for a time when the 
sodium salt causes nausea. These oils may be 
given in capsules mixed with a bland fixed oil. 

The mercurials will be discussed under the sub- 
ject of alteratives. 



CHAPTEE IV. 
GENEllAL TONICS. 

Tonics are defined by Gould as ''medicines or 
agents wliich promote nutrition and give tone to 
the system.'^ 

Since these conditions are met by any improve- 
ment in the general health, the use of the term is 
often an admission of our want of exact knowledge 
of the mode of action of the drugs or remedies so 
classed. 

Strychnin increases the reflexes and may thus 
improve the muscular tone. Bitters may increase 
the impaired appetite and digestion, which will, 
of course, improve the general condition, hence 
these agents may be spoken of as tonics ; and, if we 
were not acquainted with the organism which 
causes malarial fever, and with the effect of quinin 
on that organism, but merely knew this condition 
to be relieved by quinin, we would be justified 
in attributing the action to the tonic effect of 
quinin. Therefore, as our knowledge of the exact 
mode of action of the various remedies of this 
group increases, the importance of the term itself 
will correspondingly decline. 

Among the tonics we may include hematinics, or 

agents which assist in the regeneration of blood, 

including iron, arsenic, codliver oil and hypophos- 

phites ; the alteratives, the mode of action of which 

• is unknown, and stomachics. 



GENERAL TONICS. 91 

HEMATINICS. 

Ordinary food is the most important of the 
hematinics, if, indeed, we have any others which 
are of considerable importance, especially if we ac- 
cept the definition which includes iron in any as- 
similable form as food. 

IRON. 

Most of the iron in the body, amounting to from 
2^ to 3 grams (38 to 45 grains) occurs as a con- 
stituent of hemoglobin, an extremely complex sub- 
stance in which the iron is much more firmly 
bound than in the ordinary iron albuminate. In 
addition to that found in the blood, some iron is 
held in reserve in the liver and spleen in the form 
of the ferratin of Schmiedeberg (not the commer- 
cial Ferratin) and the cells of the body also con- 
tain small amounts of iron. 

The subject of the absorption and assimilation 
of iron has been the subject of many investigations, 
and the results have often proved contradictory, 
but it may be accepted now as definitely established 
that both the organic and the inorganic forms of 
iron are absorbed from the small intestine, that 
they are carried by the blood io the liver and the 
blood-building organs and are utilized in the form- 
ation of hemoglobin.^ 

This occurs even with doses of inorganic iron 
which are incapable of causing corrosion of the 
mucous membrane of the stomach prior to absorp- 
tion. 



1. Prior to the discovery by Wohlor of the synthesis of 
such a comparatlvoly simple substance as hlppurlc acid In 
the kidney It was supposed that no synthesis could occur In 
the animal body. 



92 PHARMACOPEIA AND PHYSICIAN. 

Dogs were rendered anemic by giving them food 
poor in iron and subjecting them to repeated 
hemorrhage. After the reserve iron of the liver 
was greatly diminished the animals were given the 
same kind of food poor in iron, but to the food of 
some was added iron in various forms, inorganic 
in some cases, organic in others. Those which 
received only the food poor in iron were unable to 
make good the loss of hemoglobin, but those re- 
ceiving the same kind of food with the addition of 
any form of iron not only increased the hemo- 
globin of their blood, but added to the reserve 
store of the liver. Bunge's theory that inorganic 
iron is useful in chlorosis only because it combines 
with the hydrogen sulphid in the intestine and thus 
spares the iron of the food from being rendered 
non-absorbable, has been proved erroneous, as no 
hydrogen sulphid could be found in the duodenum, 
where iron is mainly absorbed, and the other heavy 
metals, such as bismuth, combine with hydrogen 
sulphid, but they have no such aption as the inor- 
ganic salts of iron in anemia. 

Even if Bunge's theory concerning the absorb- 
ability of organic forms of iron were correct his 
warning against the nostrums containing iron 
should not be forgotten. Bunge specifically states 
that meat and other foods are decidedly preferable 
to those preparations. 

Abderhalden isolated from spinach a compound 
similar to hematogen, and Bunge's remarks apply 
with equal force to those preparations which con- 
tain iron of vegetable origin. 

It has been shown that a part at least of the 



GENERAL TONICS. 93 

organic iron- of the food is broken clown into sim- 
pler forms during its passage through the intes- 
tinal wall. This and the fact that ferratin of the 
liver (the probable precursor of hemoglobin) is 
not so stable as the food iron, point strongly to the 
utilization of inorganic iron in the formation of 
l)emoglobin. 

While much diversity of opinion has been held 
concerning the precursor of hemoglobin, the ques- 
tion is of less therapeutic importance than it would 
seem at first thought, in view of the fact that it is 
a comparatively infrequent occurrence that a pa- 
tient is unable to take a sufficient amount of iron 
in the food. We have devoted so much space to the 
subject mainly because the manufacturers of cer- 
tain nostrums, used as hematinics, are prone to 
quote such results as those obtained in Bunge's 
laboratory only so far as they show that organic 
iron preparations are assimilable while the inor- 
ganic are not. 

OFFICIAL TREPAEATIONS OF IRON. 

The list of official preparations of iron is a long 
one and comprises a number of substances that 
are not generally used as hematinics. 

2. Cushny : 'Tharmacology and Therapeutics" says : "The 
words organic and inorganic in connection with these prepa- 
rations have no reference to the combination to wliicli iron is 
attached, but to the method of attachment. Thus the acetate 
and albuminate of iron are both classified among the inor- 
ganic iron compounds, because they are capable of dissocia- 
tion, and the iron is precipitated by ammonium sulphld. 
Masked iron is a preferable term for organic iron, but has 
not been so widely used. A large number of the proteid com- 
pounds that have been Introduced in the last few years 
promise to be rel(>gated to merited oblivion in the near 
future. The albuminate of iron and the peptonate of iron 
are generally prepared by the action of the chlorid on egg 
albumin or on i/cptoiu', and dllTer very considerably in the 
percentage of Iron, 'ilicse prei)arations are not organic iron 
In the sense dellned above, for the iron can be split off 
easily, and Is precipitated by sulphids almost as readily as 
the ordinary salts." 



94 PHARMACOPEIA AND PHYSICIAN. 

The use of the salts of iron as astringents will 
be referred to in Chapter VIII. 

Probably the most widely used of the several 
])reparations of iron is 

TiNCTUEA Ferri Chloridi. — U. S. P. — This 
preparation contains 35 per cent, by volume of 
solution of ferric chlorid. It should be prepared 
at least three months before being used. Tincture 
of ferric chlorid, or tincture of iron, as it was for- 
merly called, has long been considered one of the 
most efficient of the inorganic iron preparations. 

Average dose: 0.5 c.c. (8 minims). 

Ferri Sulphas and Ferri Sulphas Granu- 
LATUS. — U. S. P. — These differ only in the size of 
the crystals; they consist of ferrous sulphate con- 
taining 7 molecules of water of crystallization. 
Ferrous sulphate is soluble in less than one part of 
water, but is insoluble in alcohol. 

Average dose: 0.2 gm. (3 grains). 

Ferri Sulphas Exsiccatus. — U. S. P. — Ex- 
siccated Ferrous Sulphate is a grayish-white pow- 
der that is slowly but completely soluble in water. 
About 65 grams of the exsiccated preparation are 
equivalent to 100 grams of the granulated. 

Average dose: 0.12 gm. (2 grains). 

PiLULiE Aloes et Ferri. — U. S. P. — Each pill 
contains 0.07 gm. (about 1 grain) each of exsic- 
cated ferrous sulphate, purified aloes and aromatic 
powder. 

Average dose: 2 pills. 

PiLULJS Ferri Carbonatis. — U. S. P. — This 
preparation is variously known as Blaud's pills, 
Griffith's pills or Vallet's pills. Each pill contains 



GENERAL TONICS. 95 

about 0.06 gm. (1 grain) of ferrous carbonate, 
^yith potassium sulphate, althea, tragacanth and 
gl)'cerin. 

Average dose: 3 pills. 

Ferri Carbonas Saccharatus. — U. S. P. — 
The saccharated carbonate of iron should contain 
not less than 15 per cent, of ferrous carbonate. 

Average dose: 0.25 gm. (4 grains). 

Massa Ferri CARBOisrATis. — U. S. P. — Mass of 
ferrous carbonate, better known as Vallet's mass, 
contains nearly 5 per cent, of ferrous carbonate. 

Average dose: 0.25 gm. (4 grains). 

MisTURA Ferri Composita. — U. S. P. — Com- 
pound iron mixture, or Griffith's mixture, is much 
more popular in England than in this country. It 
contains freshly precipitated ferrous carbonate sus- 
pended in a mixture of potassium sulphate, myrrh, 
S3Tup, spirit of lavender and rose water. 

Average dose: 16 c.c. (4 fluidrams). 

Of the several official preparations containing 
ferrous carbonate the pill of ferrous carbonate, 
more generally known as Blaud's pill, is probably 
the most efficient and most satisfactory. This pill 
should be freshly prepared and should not contain 
free or unchanged ferrous sulphate or potassium 
carbonate. The practice that has been adopted by 
some manufacturers of massing these pills witli- 
out allowing the chemical reaction to take place is 
a reprehensible one, as it is not at all probable that 
the necessary reaction will take place in the acid 
medium of the stomach. 

Should a nasfont ferrous carhoiiaic.' be desired it 
can readily he provided by using the foHowing 
solution : 



no PHARMACOPEIA AND PHYSICIAN. 

Ferrous sulphate 3.2 gm. 50 gr. 

Potassium carbonate 1.6 gm. 25 gr. 

Distilled water 2.0 c.c. 30 min. 

Glycerin to make 100.0 c.c. 3 fl.oz. 

Dissolve the potassium carbonate in 45 c.c. of 
glycerin and add this to the solution of ferrous 
sulphate, made by dissolving the latter, by means 
of heat, in the water and subsequently diluting 
^ith 40 c.c. of glycerin. Finally, add sufficient 
glycerin to make the mixture measure 100 c.c. 

Each teaspoonful (5 c.c.) of this mixture, when 
diluted with half a glass of water, will produce a 
quantity of freshly precipitated ferrous carbonate 
that is equivalent to one Blaud's pill. 

All the preparations of ferrous carbonate have 
the decided advantage over the previously men- 
tioned preparations of iron that they are not 
astringent and, therefore, are not likely to cause 
digestive disturbances. 

Another preparation that is free from the ob- 
jectionable feature of being astringent is : 

Ferrum Eeductum. — U. S. P. — Eeduced Iron 
occurs as a fine grayish-black lusterless powder 
without odor or taste. It is insoluble in water and 
in alcohol and, therefore, is generally directed to 
be dispensed in powders, capsules or pills. 

Average dose: 0.05 gm. (1 grain). 

SCALE SALTS OF IRON. 

Feeri Citras. — U. S. p. — Ferric Citrate occurs 
in thin garnet-red scales that are slowly but com- 
pletely soluble in water. 

Average dose: 0.35 gm. (4 grains). 

Ferri et Ammonii Citras. — U. S. P. — Iron 
and Ammonium Citrate is much more freely solu- 



GENERAL TONICS. 97 

ble in water than the simple citrate, an advantage 
that it is not likely to lose on keeping. 

Average dose: 0.25 gm. (4 grains). 

Feeei et Ammoxii Tartras. — U. S. P. — This 
occurs in thin transparent scales varying in color 
from garnet red to reddish brown. It is freely 
soluble in water, but insoluble in alcohol. 

Average dose: 0.25 gm. (4 grains). 

Ferri et Potassii Tartras. — U. S. P. — This is 
very similar in physical properties to iron and am- 
monium tartrate. 

Average dose: 0.25 gm. (4 grains). 

Ferri et QuiNiNiE Citras. — U. S. P. — Iron 
and Quinin Citrate contains about 11.5 per cent, of 
quinin, and ferric citrate corresponding in amount 
to 13.5 per cent, of metallic iron. It is slowly but 
completely soluble in water. 

Average dose: 0.25 gm. (4 grains). 

Ferri et QuiNiNiE Citras Solubilis. — U. S. 
P. — This preparation has practically the same 
composition as iron and quinin citrate, but with 
ammonium citrate present to insure its solubility. 

Average dose: 0.25 gm. (4 grains). 

Ferri et Strychnine Citras. — U. S. P. — 
Iron and Strychnin Citrate contains aljout 1 per 
cent, of strychnin. It is readily and completely 
soluble in water. 

Average dose: 0.12 gm. (2 grains). 

These several scale preparations of iron are com- 
paratively free from astringent properties, are gen- 
erally freely soluble in water, do not attack the 
teeth, and are not obnoxious to the taste. They 
are preferably directed to bo dispensed in aqueous 



98 PHARMACOPEIA AND PHYBlCIAy. 

solution, with or without the addition of elixir or 
some other flavoring admixture. 

LIQUID PREPARATIONS OF IRON. 

ViNUM Ferri.— U. S. P.— This contains 4 per 
cent, of iron and ammonium citrate with syrup 
and white wine, flavored with tincture of sweet 
orange peel. 

Average dose: 8 c.c. (2 fluidrams). 

ViNUM Ferri Amarum.— U. S. P.— This prep- 
aration contains 5 per cent, of soluble iron and 
quinin citrate with syrup and white wine, flavored 
with tincture of sweet orange peel. 

Average dose: 8 c.c. (2 fluidrams). 

Gltceritum Ferri Quinine et Strychnine 
Phosphatum.— U. S. P.— The Glycerite of the 
Phosphates of Iron, Quinin and Strychnin con- 
tains 8 per cent, of the soluble ferric phosphate, 
10 per cent, of quinin and 0.08 per cent, of 
strychnin with phosphoric acid, glycerin and water. 

Average dose: 1 c.c. (15 minims). 

Strupus Ferri, Quinine et Strychnine 
Phosphatum. — U. S. P. — This syrup contains 25 
per cent, of the glycerite of the phosphates of iron, 
quinin and strychnin in syrup. 

Average dose: 4 c.c. (1 fluidram). 

Elixir Feeri, Quinine et Strychnine 
Phosphatum.— TJ. S. P.— This popular ferrugin- 
ous bitter tonic contains soluble ferric phosphate, 
quinin and strychnin. The average dose given 
below contains nearly 0.07 gm. (1/16 gr.) of sol- 
uble ferric phosphate, 0.035 gm. (7/12 gr.^ of 
quinin, and 0.001 gm. (1/60 gr.) of strychnin. 

Average dose: 4 c.c. (1 fluidram). 



GENERAL TONICS. 99 

LiQUOE Feret et Ammonii Acetatis. — U. S. 
p. — This Solution of Iron and Ammonium Acetate, 
more popularly Imown as Basham's mixture, con- 
tains a double salt of iron and ammonium acetate 
and is directed to be made by mixing 4 parts of 
tincture of ferric clilorid, 6 parts of diluted acetic 
acid, 50 parts of solution of ammonium acetate, 12 
parts of aromatic elixir, 12 parts of glycerin and a 
sufficient quantity of water to make 100 parts. 
This preparation, being quite dilute, is not very 
stable and should be freshly prepared when wanted. 

Average dose : 16 c.c. (4 fluidrams) . 

There are two additional preparations of iron 
that, while they are not prescribed as hematinics, 
might well be mentioned in this connection. 

ANTIDOTES FOR ARSENIC. 

Ferri Hydroxidum. — U. S. P.- — This is the hy- 
drated oxid of iron of the previous Pharmacopeia 
which is directed to be made by precipitating 100 
parts of solution of ferric sulphate with 133 parts 
of ammonia water that has been diluted with 
1.000 parts of cold distilled water. The resulting 
precipitate is directed to be washed until free from 
.soluble sulphates. This preparation is not par- 
ticularly adapted for extemporaneous preparation. 
and, as it does not keep well, the following has 
been added as an efficient, extom.porancous arti- 
dote for arsenic : 

Ferri Htdroxtdttm cum Maonesti Oxido. — 
TT. S. P. — This is dirocted to bo made by diluting 
-10 parts of solution nf ferric siilpliate witli 125 
parts of water, and kept in a largo \vell-stop]-)oro(l 

LOfC. 



100 PHARMACOPEIA AND PHYSICIAN. 

bottle. The magnesia mixture is directed to be 
made by rubbing 10 parts of magnesium oxid with 
suflScient water to make a smooth and thin mixture, 
then diluting it to about 700 parts. When wanted 
for use the magnesium oxid mixture is to be well 
shaken and then gradually added to the solution 
of ferric sulphate, and the resulting mixture again 
well shaken. 

Average dose: Arsenical antidote, 120 c.c. (4 
fluidounces). 

INDICATIONS FOE IRON. 

Hematinics are demanded when the amount of 
blood or of any of its essential constituents have 
been greatly reduced. 

After severe hemorrhage involving the loss of 
less than half the blood, regeneration takes place 
rapidly, if the general condition of the patient is 
otherwise good and the food ample. 

Iron has long been used in chlorosis, and ex- 
perience has shown that it is more useful in those 
forms of anemia in which the loss of hemoglobin 
is greater than that of red blood cells; in other 
words, when the red blood cells present, whether 
in normal or diminished number, are individually 
poor in hemoglobin. 

As to the form of iron to be given, of first im- 
portance is the selection of food. Eeference to the 
table given below will enable the physician to com- 
pute approximately the amount of food iron which 
the patient is receiving, and by computing the daily 
normal loss at 10 milligrams he can see about how 
much of this is left for the regeneration of hemo- 



GENERAL TONICS. 101 

globin. The figures given are for material as 
usually served at table^ and are only approximate. 

If the food contains an insufficiency of iron, he- 
matin, or one of the inorganic forms of iron will 
prove beneficial. In our choice of medicinal iron 
we must be guided by the individual case in select- 
ing the one which causes the least disturbance of 
the digestion. In the absence of fever it will sel- 
dom occur that the patient can not take a selected 
diet containing an ample supply of iron. If the 
appetite and digestion are deficient, stomachics are 
indicated. 

Inorganic iron very often gives better results in 
the first few weeks of the administration than it 
does later, whicli may possibly be explained by its 
interference with the dijrestion — a matter to be 



3. The following table Is based on computations made by 
Bunge of the iron content in dried substances. The figures 
given here serve as an indication of the approximate content, 
in milligrams, in the amount of each article as ordinarily 
served at meals : 

Teacupful of boiled oatmeal 0.2- 0.5 

Teacupful of boiled rice 0.2- 0..5 

r>00 gm. of grapes (about one pound) 0.4- 1.0 

Two apples 0.1- 0.4 

Two oranges 0.1- 0.5 

Yolk of two eggs 2.0- 5.0 

Glass of cow's milk 0.4- 1.0 

Four small slices of white bread, about 100 gm. . . . 0.5- 1.0 

Four slices of whole wheat bread 1.0- 3.0 

Plate of pea soup, thick 0.4- 2.0 

Slice of roast beef, about 50 gm 2.0- 6.0 

Teacupful of mashed potato 0.3- 1.5 

Teacupful of boiled cabbage 0.5- 3.0 

Two heaping tablospoonfuls of spinach 2.0-10.0 

Two heaping tablospoonfuls of boiled carrots 0.3- 1.5 

Two heaping tablospoonfuls of string beans 0.4- 2.0 

Two heaping tablospoonfuls of green peas 0.3- 1.5 

SI.^ to eight leaves of lettuce 0.1- 1.0 

Four to sl.x stalks of asparagus 0.5- 3.0 

Ton or twelve almonds, blanched 1.0- 2.0 

Ton or twelve almonds, whole 2.0- 5.0 

Ten or twelve hazel nuts 1.0- 4.0 

Four to six flgs 0.5- 2.0 

Slice of "blut-wurst," about 100 gm 10.0-25.0 

Sugar and whit'- of egg are froo from Iron. 



102 PHARMACOPEIA AND PHYSICIAN. 

guarded against carefully. Large doses, if they 
do not disturb the digestion, are often required. 

While warm blood may be tolerated by some in- 
dividuals, the aversion to it is frequently uncon- 
querable and hematin seems to be equally service- 
able in any case.* 

The etiology of some of the anemias is so ob- 
scure that treatment must be mainly empirical, 
but we may feel reasonably certain that we shall 
do more harm than good if we depend on the nos- 
trums so glowingly advertised instead of directing 
our efforts toward improving the appetite and di- 
gestion. The selection of a proper diet, together 
with proper doses of inorganic iron in most cases, 
or of organic and inorganic iron in comparatively 
few cases in which they are needed, will usually bo 
found to be all that is required. 

When iron tends to cause constipation, laxatives 
must be employed, preferably one of the prepara- 
tions of cascara sagrada, or the pills of aloes and 
iron, one of which may be given three times daily. 

As examples of the innumerable combinations in 
which iron may be prescribed we give the follow- 
ing: 

B. Ferri sulphatis exsic 3i 4| 

Extract! nucis vom. | 

Extract! rhamni pursh., aa. . . .gr. xv 1| 
' M. Ft. pil. No. Ix. 

Sig. : One pill half an hour after meals. 

Eeduced iron or ferric citrate may be substi- 
tuted for the dried ferrous sulphate, and a slightly 
larger amount of aloes (30 grains — 1.3 gm.) can 
be used in place of the extract of cascara sagrada. 

4. A practical method for the economic preparation of a 
hematin product was described by Torald Sollmann, in the 
Am. Jour, of Phar., June, 1902, p. 275. 



GENERAL TONICS. 103 

Clinical experience seems to show that a formula 
of this kind is not so useful in those conditions in 
which there is a deficiency of hydrochloric acid in 
the gastric secretions; in such cases small doses, 
from half to one teaspoonful. of the solution of 
iron and ammonium acetate may be given, after 
meals. This preparation rarely gives rise to con- 
stipation or other symptoms of indigestion. It is 
not very stable and should be dispensed in small 
amounts. 

The pills of ferrous carbonate, Blaud^s pills, 
may be given either alone, or the mass of ferrous 
carbonate, which is practically identical, may be 
used in combination with such a laxative as the 
extract of cascara sagrada, in the dose mentioned 
above. If desirable a bitter substance such as the 
extract of nux vomica may also be included as 
follows : 

IJ. MassjE ferri carbonatis 3ii 8| 

Extracti micis vom. | 

Extraeti rhamni pursli., aa . . . .gr. xv 1| 
M. Ft. pil. No. Ix. 

Sig. : One pill half an hour after eating. 
Other bitter extracts, or other bitter substances, 
such as quinin or strychnin, and other laxatives 
may be substituted for those given above. A rep- 
resentative formula for a pill of this general com- 
position would be as follows: 

IJ. Ferri reducti [ 

Qiiinina; sulphatis 

Aloos pnrificat, afi gr. xlv 3| 

Strychninaj snlph -gr. i |0G 

Ext. gentian q. s. | 

M. Ft. pil. No. Ix. 
Sig.: One pill three times a day after eating. 

While it is true that the salts of the alkaloids 
might bo substituted by t1io alkaloids themselves, 



104 PHARMACOPEIA AND PHYSICIAN. 

the amount of acid present is so small that it is 
really of very little moment. 

In this same connection it may be pointed out 
that the dried ferrous sulphate or the ferric citrate 
may be substituted for the reduced iron, or, by 
omitting the extract of gentian, the mixture may 
be directed to be dispensed as a powder in capsules. 

The tincture of ferric chlorid is best given well 
diluted with water, a glass tube being used to pre- 
vent the corrosive action of the acid on the teeth, 
and the mouth should then be well rinsed with 
water, or a dilute solution of an alkali such as 
lime water. 

The scale salts of iron, being generally com- 
binations with organic acids, are much less cor- 
rosive than the chlorid, or either of the sulphates, 
and may frequently be used with advantage in 
their stead. A representative formula for a simple 
solution of this kind would be as follows : 

IJ. Ferri et ammonii citratis 3i 4 

Aquae dest fld. 3xii 50 

Elixir q. s. ad fld. giii 100 

M. Sig.: One teaspoonful three times a day before 
eating. 

Any one of the soluble scale salts of iron can be 
substituted for the iron and ammonium citrate, 
and one of the aromatic waters can be used in place 
of the distilled water, or of the water and the 
elixir. 

The official bitter wine of iron, given a few min- 
utes before meals, is an excellent ferruginous stim- 
ulant of the appetite and digestion which women 
will usually find acceptable. 



GENERAL TONICS. 105 

MANGANESE. 

Manganese is not absorbed in appreciable 
amounts from the alimentary canal after medici- 
nal doses. Its use as a hematinic is based on its 
supposed property of neutralizing the hydrogen 
sulphid in the intestine^ and thus sparing the iron 
of the food^ but the fallacy of this theory has been 
mentioned. Manganese would, therefore, not be 
mentioned here if it were not for its widespread 
use, thanks mainly to the methods used in exploit- 
ing the nostrums containing it. 

The report of the Commission for the Study and 
Treatment of Anemia in Porto Eico was pub- 
lished by the government of that island in Decem- 
ber, 1904. This report, which was the subject of 
editorial comment in The Journal of the Ameri- 
can Medical Association, confirms the use of inor- 
ganic iron in anemia. 

The misuse of this report by the M. J. Breiten- 
bach Company furnishes an example of the distor- 
tion of facts by nostrum makers to suit personal 
ends. The Journal of Sept. 23 and Oct. 7, 
1905, exposed tliis misrepresentation of the report 
of the commission, and later it gave a careful anal- 
ysis of a report of tlie use of Gude's Pepto-mangan 
in 32 cases of anemia in the Infants' Hospital on 
Kandall's Island. The analysis is brief and con- 
vincing and will repay perusal by any one who 
uses that nostrum. 

The so-called peptonized manganese prepara- 
tions, generally solutions of peptone to which some 
salt of manganese has l^een added, may be obtained 
from reput-ible dealers in pharmaceuticals, or may 
be made by any rotail pharmacist who lins the 



106 PHARMACOPEIA AND PHYSICIAN. 

necessary educational qualifications to conduct 
even the very simplest chemical experiments. 

Peptonates were introduced, upwards of twenty 
years ago, by E. Dietrich, who published detailed 
directions for preparing them. His formulas have 
frequently been republished, and his processes are 
sufficiently simple to be followed by even a tyro. 
A number of manufacturers in this country and 
abroad have adopted them, and not a few of the 
proprietary preparations now on the market, con- 
sisting of variable mixtures of iron, manganese 
and peptone, are but poor substitutes for the 
original preparation proposed by Dietrich. 

The commercial dry peptonates are not elegant 
preparations, and physicians who are desirous of 
avoiding the use of proprietary articles will do 
well to have their neighboring pharmacist prepare 
for them a solution of the peptonates according to 
Dietrich's original formula, or the modification, 
proposed by Dunning, in the Proceedings of the 
American Pharmaceutical Association for 1905. 

OFFICIAL PREPARATIONS OF MANGANESE. 

The official preparations of manganese are lim- 
ited in number, and, as suggested above, are even 
more limited in their practical application as 
tonics or hematinics ; they are : 

Mangani Dioxidum Pr^cipitatum. — U. S. P. 
— Precipitated Manganese Dioxid is a new prepar- 
ation that has been added to replace the crude 
product formerly official. Manganese dioxid is 
directed to be made from manganese sulphate and 
should contain not less than 80 per cent, of man- 
ganese dioxid. 

Average dose: 0.25 gm. (4 grains). 



GENERAL TONICS. 107 

Man-gani Sulphas. — U. S. P. — This occurs as 
colorless or pale pink crystals that are soluhle in 
less than one part of water, but insoluble in al- 
cohol. 

Average dose: 0.25 gm. (4 grains). 

PoTASsii Permangan-as. — IT. S. P. — This sub- 
stance has been mentioned in the chapters on dis- 
infectants and antiseptics. In connection with 
tonics or hematinics it is of interest only as the 
source of some of the now popular organic prepara- 
tions of manganese. 

ARSENIC. 

It is not positively known whether arsenic is an 
essential constituent of the human body or not. 

Segale, using penicillium brevicaule, with which 
infinitesimal quantities of arsenic may be detected, 
found it widely distributed in animal tissues, and 
Bertrand found it in eggs, particularly in the yolk. 

Wieser concluded that arsenic is not a constant 
constituent in animal and himian tissues, but that 
it is accidentally present. 

When one considers the distribution of arsenic 
in plants, in sea water and in many springs, it is 
apparent that abundant opportunity occurs for its 
entrance into the body, and, owing to its slow ex- 
cretion, tbe organism may rarely be without traces 
of it. 

If minute traces of arsenic are essential to the 
well-being of the body we may be sure that the 
ordinary food insures an abundant supply. 

Gies found tbat those members of a litter of 
rabbits which received arsenic grew faster than the 
others, while female rabbits under its influence 
bore larger young. This increased rapidity of 



108 PHARMACOPEIA AND PHYi<WIAN. 

growth has been observed by some, but not all, sub- 
sequent investigators. In this connection the ob- 
servation of arsenic in the yolk of egg is at least 
suggestive. 

The toxicology of arsenic is of peculiar interest 
because of its frequent use with fatal effect and 
because the appearance of the earliest symptom is 
used as a guide in its therapeutic use. 

The most striking effect of acute arsenical 
poisoning is seen in the symptoms closely resem- 
bling those of Asiatic cholera, which are explain- 
able by the characteristic action on the capillaries, 
particularly those of the abdominal region. 

The capillaries appear to suffer a peculiar paral- 
ysis and dilation, resulting in an enormous increase 
in permeability. The escaping plasma of the blood 
makes its way into the intestine, and, coagulating, 
gives rise to the "rice-water" stools. The with- 
drawal of the blood from the rest of the body into 
this region and its loss, as mentioned, causes the 
usual symptoms of collapse. 

The direct effects on the heart are too slight in 
such cases to be considered important, and the 
corrosive action of arsenic is too slowly developed 
to be concerned in the immediate effects just de- 
scribed, which rapidly follow the absorption of a 
poisonous dose. When the poisoning is more slow- 
ly developed, however, as after frequently repeated 
smaller doses, catarrh of the gastrointestinal tract 
is seen and fatty degeneration of various organs 
takes place, the picture somewhat resembling that 
seen after phosphorus poisoning. 

Even therapeutic doses frequently repeated give 



GEXERAL TOyiCS. 100 

rise to effusion of liquid, commonly noticeable in 
the swollen e^-elids. 

Arsenic is said to be capable of increasing the 
number of erythrocytes in anemia through its 
action on the bone marrow, but Engel found no in- 
crease in the mature red blood cells in anemia ; 
other observers failed to see any change in the red 
blood cells or in the hemoglobin. 

It has been claimed that arsenic actually dimin- 
ishes the number of red blood cells in chlorosis 
without altering the total amount of hemoglobin. 

It has been suggested that the influence of ar- 
senic on metabolism is due to alternate reduction 
and oxidation, arsenous and arsenic acids being re- 
peatedly formed, but this seems hardly probable. 

Arsenic is, in part, excreted in the urine, feces 
and other excretions, but a part is stored in vari- 
ous organs of the body. 

Heffter could find but little arsenic in the bones 
after long-continued administration; this is con- 
trary to the theory that arsenate of calcium may 
replace the phosphate in bones. 

An arsenical powder containing as high as 0.3 
per cent, of arsenic may be obtained by causing 
yeast to grow in increasing concentrations of ar- 
senic. 

Tlio organic compounds, including cacodylic 
acid and its salts, are less poisonous than the in- 
organic conipoiiiids, because the arsenic is nioir 
firmly bomnl iiiid, for the same reason, thev arc 
less effective therapeutically. They are poisonous. 
however. It has been erroneously stated that 
atoxyl (wliicli is the sodium salt of para-amino- 
phcnyl arsenic acid) can be given in doses fifty 
times as great as tliose of tlio inoriranic salts.- 



no PHARMACOPEIA AND PHYSWIAN. 

OFFICIAL PREPARATIONS OF ARSENIC. 

Arseni Trioxidum. — U. S. P. — Arsenic Tri- 
oxid was formerly official as Acidum Arsenosum. 
It consists of not less than 99.8 per cent, of pure 
arsenic trioxid. It may occur in transparent 
masses, like glass, or in opaque masses, resembling 
porcelain; more frequently, however, it is found 
as an odorless and tasteless white powder that is 
slowly but completely soluble in 100 parts of water, 
but very sparingly soluble in alcohol. The pres- 
ence of either alkalies or halogen acids facilitates 
the solution of arsenic trioxid, and this fact is 
taken advantage of in the preparation of the sev- 
eral official solutions. White arsenic, as it is still 
called, was not known in Europe until some time 
after the eleventh century. It was scarcely well 
defined until 1733, when Brandt accurately deter- 
mined its nature and leading chemical properties. 

Average dose: 0.002 gm. (2 mg. or 1/30 grain). 

Arseni Iodidum. — U. S. P. — Arsenous lodid 
occurs as an orange red, inodorous crystalline pow- 
der. It is soluble with partial decomposition, in 
about 12 parts of water and in about 28 parts of 
alcohol. 

Average dose: 0.005 gm. (5 mg. or 1/10 grain). 

SoDii Arsenas. — U. S. P. — This occurs as color- 
less, transparent, odorless prisms that are soluble 
in less than two parts of water, but very sparingly 
soluble in alcohol. 

Average dose: 0.005 gm. (5 mg. or 1/10 grain). 

SoDii Arsenas Exsiccatus. — U. S. P. — This 
should contain not less than 98 per cent, of pure 
anhydrous di-sodium-ortho-arsenate. It occurs as 
an amorphous white powder, permanent in dry 



GENERAL TONICS. Ill 

air; it is soluble in about three parts of water and 
is practically double the strength of the h3'drous 
or cvstalline preparation mentioned above. 

Average dose: 0.003 gm. (3 mg. or 1/20 grain). 

SOLUTIONS OF ARSENIC. 

While several of the preparations of arsenic ap- 
pear to have been used from time immemorial as 
topical applications, the internal use of arsenic, in 
Europe, appears to date from the introduction of 
the solution of potassium arsenite, popularly 
known as Fowler's solution, about 1786. During 
the following decades a number of modifications of 
this solution of arsenic were suggested by medical 
practitioners and apothecaries, all of which had, 
or were supposed to have, some distinctive proper- 
ties. Of these almost innumerable solutions that 
have been proposed during the past century, the 
following are now official : 

Liquor Potassii Arsenitis. — U. S. P. — The 
Solution of Potassium Arsenite, universally known 
as Fowler's solution, as noted above, was the first 
of the several solutions to be used and is even now 
the most popular, being known in every civilized 
country in the world. 

Solution of potassium arsenite contains the 
equivalent of 1 per cent, of arsenic trioxid, with a 
sufficient amount of the compound tincture of 
lavender to give the preparation a distinctive color 
and flavor. 

Average dose: 0.2 c.c. (3 minims). 

LiQUOii AciDi Arsenosi. — U. S. P. — Tliis Solu- 
t'on of Arsenous Acid contains tlie equivalent of 1 
per cent, of arsenic trioxid, witli 5 per cent, of 



112 PHARMACOPEIA A^D PHYSICIAN. 

diluted hydrochloric acid. This preparation was 
introduced about the end of the eighteenth cen- 
tury by Dr. De Valanquin, in London; it was the 
first of the several acid preparations of arsenic. 

Average dose: 0.2 c.c. (3 minims). 

Liquor Arseni et Hydrargyri Iodidi — U. S. 
P. — This preparation, more popularly known as 
Donovan's solution, contains 1 per cent, each of 
arsenous iodid and mercuric iodid. 

Average dose: 0.1 c.c. (II/2 minims). 

Liquor Sodii Arsenatis. — TJ. S. P. — This So- 
lution of Sodium Arsenate, also known as Pearson's 
solution, contains 1 per cent, of exsiccated sodium 
arsenate. 

Average dose: 0.2 c.c. (3 minims). 

Solutions of arsenic containing a bromid have 
also had their advocates, in times gone by, and 
several of these are still used to some extent. The 
present edition of the National Formulary contains 
two formulas for preparations of this type: 

Liquor Potassii Arsenatis et Bromidi. — N. 
F. — This preparation, at one time widely known as 
Clemen's Solution, represents the equivalent of 1 
per cent, of arsenic trioxid in combination, prob- 
ably as arsenate, and bromid of potassium. 

Average dose: 0.2 c.c. (3 minims). 

Liquor Auri et x4.rseni Bromidi. — IST. F. — So- 
lution of bromid of gold and arsenic represents in 
each 0.6 c.c. (10 minims) 0.002 (2 mg. 1/32 
grain) of tribromid of gold and the equivalent of 
0.005 (5 mg. 1/13 grain) of tribromid of arsenic. 

Average dose: 0.2 c.c. (3 minims). 

The several solutions of arsenic are best admin- 
istered with simple diluents, and not in complex 



GEXERAL TONICS. 113 

mixtures. Arsenic trioxid and other arsenic com- 
pounds may also be given to advantage in pill 
form. 

THERAPEUTICS OF ARSEXIC. 

While the probability of favorably influencing 
nutrition under certain conditions, by means of 
the action of arsenic on the capillaries, can not be 
doubted, its therapeutic use for such purposes is 
empirical. The use of arsenic as a local caustic has 
a rational basis, but that will not be discussed here. 

Arsenic has long been used in the treatment of 
a great variety of complaints in which anemia is 
a prominent symptom. Among these conditions 
is remittent fever, in which it is given in connec- 
tion with quinin. It is preferable to give the two 
separately, arsenic being used in the form of the 
solution of potassium arsenite, which has a wide 
range of pharmaceutic incompatibility. This solu- 
tion may be given in large doses — ten drops — grad- 
ually reduced, or in small doses rapidly increased 
until intestinal symptoms or swelling of the eye- 
lids is seen, after which the drug is to be discon- 
tinued for a time, and then given in doses of from 
three to five drops three times a day. It is of im- 
portance that the dosage be watched so that no 
serious disturbance of digestion may occur. The 
frequently made suggestion to combine prepara- 
tions of opium with the preparation of arsenic, so 
as to establisli a tolerance for the latter, is one that 
is of doii])tful utility in view of the fact that 
opium would be likely to mask the symptoms that 
occur as forerunners of more serious distui'lyancos. 

In chlorosis, arsenic seems to be useful in con- 
nection witli iron. Tlie oombiuiition iiio.^l IVc- 



114 PHARMACOPEIA AND PHYSICIAN. 

qucntly prcgC'ril)ecl is a pill of ferrous carbonate 
with arsenic trioxid. For this purpose the latter 
may be combined with the official pill, or the mass 
of ferrous carbonate, as follows : 

IJ. Massae ferri carbonatis 3i 4| 

Arseni trioxidi gr. i |05 

M. et div. in pil No. xl. 

Sig. : One pill three or four times a day. 

Pernicious anemia may show some temporary 
improvement under arsenical treatment, but the 
effect is not permanent. 

The use of arsenic in diseases caused by trypano- 
somes, particularly the "sleeping sickness," has at- 
tracted considerable attention of late. 

It has been said that lymphosarcoma has shown 
improvement under its use. and the following con- 
ditions are enumerated among those in which it 
has been employed: Dyspepsia, diseases of the 
skin dependent on nutritional derangements, 
cachectic conditions resulting from diabetes, tuber- 
culosis and a number of other more or less well- 
defined diseases. 

The use of arsenic among veterinary surgeons 
for improving the appearance of horses by in- 
creasing the glossiness of the hair and adding to 
the fat under the skin is well known. 

PHOSPHORUS. 

Phosphorus, in both inorganic and organic com- 
bination, is widely distributed in the body. Leci- 
ithin, a compound of cholin with phosphoric and 
fatty acids, occurs in nearly all living animal and 
vegetable tissues, while the nucleins, which are 
also rich in phosphorus, are likewise widely dis- 
tributed. 



GENERAL TONICS. 115 

While some observers have found that when 
lecithin or niiclein was added to the food of ani- 
mals the latter grew faster than the controls which 
were not given these compounds, these results are 
not universally accepted as proving their value, 
and we have the classic research of Miescher, 
which proves that the animal organism is abun- 
dantly able to form those compounds from others 
normally existing in the body. 

Miescher found that the mass of eggs in the 
salmon increased from 0.4 per cent, to from 19 to 
37 per cent, of the total body weight during some 
months when the salmon took no food, while the 
muscles showed a corresponding loss in weight. 
Much more nuclein and lecithin are found in the 
eggs than previously existed in the muscle, which, 
however, are rich in other phosphoric-acid com- 
pounds, probably potassium salts which are loosely 
bound to the proteid. 

Micsclier concludes, and the evidence seems in- 
controvertible, that the newly formed combinations 
characteristic of the egg (including lecithin and 
nuclein) are formed by chemic action from the 
albumin, fat and phosphates of the muscle. 

It will be seen how the makers of nostrums can 
use such results as those quoted in regard to the 
action of lecithin in causing an increase in the 
body weight, while the much more important and 
generally accepted results of Miescher are ignored. 

The presence in the brain and nerves of an abun- 
dance of compounds ricli in phosphorus has led to 
the mistaken idea tliat their pliysiologic impor- 
tance is an index of the therapeutic value of or- 
ganic and inorganic proparation.'^ of pliosphonis. 



IKi PHARMACOPEIA AND PHYSICIAN. 

Lecithin and nuclein have l)een extravagantly 
lauded in the treatment of the greatest variety of 
diseases, but who would venture to attribute extra- 
ordinary curative properties to eggs used in doses 
of one-fourth of the yolk of one egg, yet the yolk 
of an egg does actually contain enough lecithin for 
four ordinary doses, or about 1.8 gm. (28 gr.) in 
a perfectly available form. 

Nuclein and lecithin are very widely distributed, 
and our food always contains much more than the 
amounts advised for therapeutic administration. 

Phosphorus and its preparations might be omit- 
ted without serious detriment to this chapter, but 
for the fact that they have been so widely used 
and, therefore, require at least a passing notice, 
particularly as the toxicology of phosphorus is of 
considerable interest. 

The heart suffers greater direct injury in phos- 
phorus poisoning than does any other organ, while 
the accumulation of fat which it causes in the liver 
is apparently an infiltration, resulting from a 
peculiar disturbance of metabolism rather than the 
result of any change in the organ itself. 

Hemorrhages may occur from degeneration of 
the capillary walls, while a similar effect on the 
mucous membranes of the stomach and intestine 
causes pain, vomiting and diarrhea. 

Minute doses of phosphorus, long continued, in- 
duce a peculiar change in the growth of the bones 
in the young, leading to the deposition of dense 
bone where cancellous is being formed, or the 
change of the latter, when already formed, into the 
compact form. 



GESERAL TOXICS. 117 

The phosphates are of the very greatest im- 
portance in the phmt and animal bodies, but they 
occur so abundant!}- in the soil and in ordinary 
food that there is seldom any defic'ency in the sup- 
ply, and any want of them in the human body 
must be due to the inability to use that which is 
offered. Schmiedeberg calls attention to the for- 
mation of the egg shell as evidence of the great 
capacity of the animal organism to supply a special 
demand. 

Sollmann states that there is absolutely no 
scientific foundation for the popular belief that 
the hypophosphites improve nutrition in anemia 
and beginning phthisis, while Cushny states that 
most reliable investigators deny that they have any 
other influence on nutrition and digestion than 
that of the better known and cheaper salts of lime, 
soda or iron, and Schmeideberg appears to think 
them entirely unworthy of notice. 

Many clinicians, on the other hand, appear to 
have observed a distinct improvement in the appe- 
tite and digestion under the influence of the hypo- 
■phosphites, but, even if such is the case, there 
seems to be absolutely no reason or excuse for our 
employing such a high-priced, unsightly and un- 
scientific preparation as the muddy-looking Fel- 
lows' syrup, since any competent pharmacist can 
make a more presentable and more satisfactory 
preparation at a ver}^ much smaller cost. 

The official preparations of phosphorus in its 
different forms afford evidence of the necessity for 
more careful scrutiny of the scientific claims of 
iiiO(licinal preparations before admitting them to 
the lMi;irniafO])('in. if it is \o cninniniiil tho support 



118 PHARMACOPEIA AND PHYSICIAN. 

of scientific and progressive physicians rather than 
pander to a numerous, though less, discerning 
clientage. 

OFFICIAL PREPARATIONS OF PHOSPHORUS. 

Phosphorus. — U. S. P. — A translucent, nearly 
colorless solid, having at ordinary temperatures 
about the consistency of beeswax. 

Phosphorus is nearly insoluble in water, but is 
soluble in 350 parts of alcohol and in 50 parts of a 
fatty oil. 

Average dose: 0.0005 . gm. (0.5 mg. 1/128 
grain). 

Pilule Phosphori. — U. S. P. — Each pill con- 
tains 0.0006 gm. (0.6 mg. 1/100 grain). 

Average dose: 1 pill. 

AciDUM Phosphoricum. — U. S. P. — This con- 
tains 85 per cent, of absolute orthophosphoric acid. 
It is usually prescribed as : 

AciDUM Phosphoricum Dilutum. — U. S. P. 
— This contains 10 per cent, of absolute ortho- 
phosphoric acid. 

Average dose: 2 c.c. (30 minims). 

Phosphoric acid has many of the properties of 
other (inorganic) acids, and probably has no evi- 
dent advantage over them as a tonic. 

The official salts of phosphoric acid usually par- 
take of the properties of the base rather than the 
acid, and need not be mentioned in this connection. 

AciDUM Hypophosphorosum. — U. S. p. — This 
contains 30 per cent, of absolute hypophosphorous 
acid and is chiefly used in preparing: 



GENERAL TONICS. 119 

AciDuzki Hypophosphoeosum Dilutum. — U. S. 
p. — This contains 10 per cent, of absolute hypo- 
phosphorous acid. 

Average dose: 0.5 c.c. (8 minims). 

The official salts of hypophosphorous acid are : 

Calcii Hypophosphis. — U. S. P. 

PoTAssii Hypophosphis. — U. S. P. 

SoDii Hypophosphis. — U. S. P. 

Average dose of any one of the above : 0.50 gm. 
(71/2 grains). 

Potassium hypophosphite is soluble in about 0.5 
part of water and in 25 parts of alcohol, and cal- 
cium h3'pophosphite is soluble in about 7 parts of 
water, but is almost insoluble in alcohol. 

In addition to the alkali hypophosphites, we also 
have official : 

Feeri Hypophosphis. — U. S. P. — and : 

Mangani Hypophosphis. — U. S. P. 

Average dose of either: 0.20 gm. (3 grains). 

The ferric hypophosphite is soluble in 2,300 
parts of water, but is much more readily soluble in 
solutions of hypophosphorous acid and the alkali 
citrates. Manganese hypophosphite is soluble in 
about 7 parts of water. 

Syrupus Hypopiiosphitum. — U, S. P. — Syrup 
of hypopliosphites contains in 100 c.c. 4.5 gm. of 
calcium hypophosphite and 1.5 gm. each of sodium 
and of potassium hypophosphites. 

Average dose: 8 c.c. (2 fiuidrams). 

Syrupus JHypophosphitum Compositus. — U. 
S. P. — Compound Syrup of Hypophosphites con- 
tains, in eacli average dose (8 c.c. = 2 fluidrams) 
altoul 0.•^■') gill. (1 grains) of calcium liypophos- 



120 PHARMACOPEIA AND PHYSICIAN. 

phite, 0.12 gm. (2 grains) each of potassium hypo- 
phosphite and of sodium hypophosphite, 0.015 gm. 
(1/4 grain) each of ferric hypophosphite and of 
manganese hypophosphite, 0.008 gm. (% grain) of 
quinin, 0.0008 gm. (1/80 grain) of strj'chnin with 
sodium citrate, hypophosphorous acid and syrup. 

Average dose: 8 c.c. (2 fluidrams). 

Syedpus Calcii Lactophosphatis. — U. S. P. 
— This syrup contains in 100 c.c, about 3 gm. of 
calcium lactophosphate with free lactic and phos- 
phoric acids. 

Average dose: 8 c.c. (2 fluidrams). 

The several salts of glycerophosphoric acid which 
are being advertised so extensively at the present 
time, as the active constituents of a number of nos- 
trums are, as yet, not offlcial. The chemistry of 
the glycerophosphates is, however, well understood, 
and there is no reason why any reliable pharmacist 
can not supply preparations containing them. The 
third edition of the ISJ'ational Formulary includes 
the formula for an elixir that may be considered as 
being typical of this class of preparation. 

Elixir Glycerophosphatum, IST. F. The average 
dose, -i c.c. (1 fluidram) contains 0.065 (1 
grain) of sodium glycerophosphate and 0.032 (% 
grain) of calcium glycerophosphate. 

THERAPEUTICS OF PHOSPHORUS AND ITS SALTS. 

There is at least a rational basis for the use of 
phosphorus in rickets, osteomalacia and fracture 
of bones in which union fails to occur, since a depo- 
sition of lime salts in bone has l)Gen shown to re- 
sult from its use. 



GENERAL TONICS. 121 

It must not be given in doses large enough to 
cause serious gastrointestinal disturbance. 

AVhen we say that phosphorus or the hypophos- 
phites are used empirically in the following con- 
ditions it is not to be understood that we recom- 
mend them, but merely that they may possibly be 
worthy of a trial. Thus some clinicians have used 
phosphorus in a variety of nervous disorders, and 
the hypophosphites are very often used as general 
tonics. The treatment of tuberculosis by the 
hypophosphites has no place in modern therapeu- 
tics. 

Phosphorus is so slightly soluble in water that it 
was formerly often used dissolved in oil. but the 
phosphorated oil is no longer official. The pills of 
phosphorus, each containing 0.6 milligrams (1/100 
grain) afford a very convenient form for adminis- 
tration. 

The compound syrup of the hypophosphites. 
with its eleven ingredients, including water, af- 
fords an example of the concessions made, by the 
revision committee of the Pharmacopeia, to pop- 
ular prejudice, and it should l)e dropped at the 
next revision. 

The claim has been made that the hypophos- 
phites are effective only when tlic chemically pure 
salts are used ; this claim, however, seems scarcely 
credible in view of the fact that our ordinary food 
contains much greater quantities of just such salts 
as arc said to render the hypophosphites useless. 

From one to. two teaspoonfuls of the compound 
syrup of the hypophos])hites may be given before 
meals, as a stimiihint lo the appetite and diges- 
tion. Acids and acid fruits are to be avoided. 



122 PHARMACOPEIA AND PHYSICIAN. 

The following may be taken as a type formula 
for an extemporaneous preparation of the hypo- 
phosphites : 

IJ. Calcii liypophosphitis 
Sodii hypophosphitis 

Potassii hypophosphitis, aa 3i 4 

Aeidi hypophosphorosi 3i 4 

Aquae dest 5iv 120 

Elixir q. s. ad 5viii 250 

M. et filtra. 
Sig. : One or two teaspoonfuls three times a day be- 
fore eating. 

The elixir in this preparation may be replaced 
by glycerin, or an aromatic water, the combina- 
tion of the hypophosphites may be varied, within 
reasonable limits, and the hypophosphorous acid 
substituted by citric acid or by an alkali citrate. 
When desirable sufficient bitter may be added to 
make the medicine more palatable or to act as a 
bitter tonic. For this purpose the tincture of nux 
vomica, or one of the bitter alkaloids, may be 
added. 

COD-LIVER OIL. 

The consideration of cod-liver oil rightly be- 
longs under the subject of dietetics, as nearly all 
pharmacologists are agreed that it is merely a 
food, but it is so frequently lauded as a medicine 
that some mention of it is necessary in this place. 

On the discovery of traces of certain alkaloids or 
ptomains it was suggested that they possessed ex- 
traordinary value, but, as these substances are 
usually present in infinitesimally small and vary- 
ing quantities in good oil, and as there is no rea- 
son to suppose that they possess any beneficial 
effect whatsoever, it can not be said that the so- 



GENERAL TONICS. 123 

called fat free or tasteless preparations can repre- 
sent cod-liver oil in any sense of the word. 

The crude dark-colored oil often contains a 
much larger proportion of free fatty acids than 
the white does, and it should, therefore, be more 
readily emulsified in the intestine and absorbed, 
but its disagreeable odor and taste render it pe- 
culiarly disgusting to patients with delicate 
stomachs. Small doses of cod-liver oil can usually 
be borne, especially if it be given in the form of 
an emulsion, but even this is not always tolerated. 

OFFICIAL PREPARATIONS OF COD-LIVER OIL. 

Oleum Moerhu-s:. — U. S. P. — This preparation 
is official in some of the foreign pharmacopeias as 
Oleum Jecoris Aselli, a name that may be useful 
on occasion. Cod-liver oil is a fixed oil obtained 
from the fresh livers of Gadus morrJiuce and of 
other species of Gadus. 

Average dose: 15 c.c. (4 fluidrams). 

EiiULSUM Olei Morrhu^. — IT. S. P. — The 
Emulsion of Cod-liver Oil contains 50 per cent, of 
the oil. with mucilage and syrup, and is flavored 
with oil of gaultheria. 

Average dose: 8 c.c. (2 fluidrams). 

Emulsum Olei MoRRiiuiE cum Hypophos- 
piiiTiBus. — U. S. P. — This contains 50 per cent, 
of cod-liver oil, 1 per cent, of calcium hypophos- 
phite, and 0.5 per cent, each of potassium hypo- 
phosphite and of sodium hypophosphite. It is 
flavored with oil of gaultheria. 

Average dose: 8 c.c. (2 fluidrams). 

Cod-liver oil is often useful in anemias due to 
faulty nutrition and in the general debility which 



124 PHARMACOPEIA AND PHYSICIAN. 

SO often precedes tuberculosis. For this reason, 
perhaps, it has acquired a particular reputation in 
the treatment of tuberculosis. It can have no 
specific action on the bacillus of tuberculosis, or 
on the course of the disease, except in so far as it 
is a readily assimilable food. 

It is often found to be useful in rickets. The 
pure oil, the emulsion, or the emulsion with hypo- 
phosphites may be used, the dose to be regulated 
according to the capacity for assimilation of the 
individual case. 

It may be added here that the petroleum oils 
alone, or in the form of emulsions, are wholly de- 
void of nutrient properties. They are mineral oils. 
and, therefore, non-saponifiable and can take no 
part in animal nutrition. 



CHAPTEE V. 

ALTEEATIVES. 

Alterative is a term somewhat loosely applied 
to tonics, which, in some unlaiown wa)^, favorably 
influence the processes of nutrition which have 
been disturbed by disease. They include hema- 
tinics, the various preparations of mercury, and 
many, if not all, the preparations containing iodin, 
either free or in combination. 

A number of drugs of vegetable origin, such as 
sarsaparilla, were formerly classed as alteratives, 
but these are, for the most part, merely purgatives, 
or else devoid of therapeutic interest. 

The use of the thyroid gland in thyroid disease 
and in obesity, and of the newly discovered serum 
of Beebe in exophthalmic goiter, have a scientific 
basis, but the employment of iodids in rheumatism 
and in syphilis, and of the mercurials in the latter 
disease is empirical, and in this connection the 
pharmacolog}' of these agents is of minor impor- 
tance eince it throws little light on their therapeu- 
tic application. 

Wliile the attempts to investigate the action of 
tiiRsc agents have not led to satisfactory results, 
wc may refer to the conclusions of J. Levi, who 
sought to compare the effect of mercurials and of 
potassium iodid on the metabolism and on the 
l)l()i)d of syphilitics. He used potassium iodid and 
various organic and inorganic preparations of 



126 PHARMACOPEIA AND PHYSICIAN. 

mercury in the second stage of the disease in 252 
patients. 

Levi found that mercurials increase organic 
combustion and hasten metabolism in this condi- 
tion. With the gradual disappearance of the dis- 
ease the processes of nutrition improve, but re- 
lapses are frequent. He found no evidence, how- 
ever, of a specific influence on the micro-organism 
of syphilis, but according to the most recent view 
mercury is antagonistic to this micro-organism. 

If the use of mercurials be too greatly pro- 
longed the number of red blood corpuscles is 
diminished. Levi found that potassium iodid had 
a similar general influence on the nutrition of 
syphilitics. While it causes an increase in the 
body weight, improves the blood, and adds to the 
muscular strength, it retards combustion and less- 
ens metabolism. He explains its uses in tertiary 
syphilis by supposing that it neutralizes the dis- 
ease products without increasing organic combus- 
tion. 

Nearly all observers are agreed that the action of 
mercurials is almost wholly independent of the 
preparation chosen, the only essential for its ac- 
tion being that it shall be absorbed. Mercury 
probably circulates as an albuminate, which is sol- 
uble in the blood because of the excess of proteids 
and chlorids which it encounters there. 

Owing to the obscurity of many of the symp- 
toms of syphilis, and also to the fact that a com- 
paratively large number of people are not willing 
to have it known to their physician that they suf- 
fer with such a loathsome disease, the condition is 
peculiarly favorable for the practice of charla- 



ALTERATIVES. 127 

tans. While there is no disease that more ur- 
gently demands the skill and judgment of the 
specialist, there is none, perhaps, that is so fre- 
quenth' treated by incompetents and even by pa- 
tients themselves. 

While we have ahvays with us tlie humiliating 
spectacle of numerous nostrums ostensibly adver- 
tised only to the medical profession, some of them 
of vegetable origin and wholly worthless in syph- 
ilis, others consisting of one form or another of 
mercury and possessing few or no advantages over 
the old and better known official mercurials, we 
are also daily confronted with advertisements 
which disgrace our boasted civilization in that they 
seek to persuade the deluded victims to palter with 
the use of nostrums in the vain effort to treat 
themselves. 

MERCURY AND THE MERCURIALS. 

Hydrargyrum. — U. S. P. — Mercury, or quick- 
silver, has been known from remote antiquity, and 
from the earliest times it has played an important 
part, not alone in the industries, arts and supersti- 
tions, but also in the medical practices of the peo- 
ple who were acquainted with it. 

It is widely used for external application as well 
as for internal administration in the form of prep- 
arations produced by mechanical subdivision of 
the mercury. Several of the preparations of mer- 
cury have been mentioned under other headings, 
and we shall only mention a, few of the salient 
features of those several substances. 

irvDKAi.'cviMM cum Creta. — U. S. P. — Mer- 
cury willi ('linlk. also known as gray powder, rep- 



128 PHARMACOPEIA AND PHYSICIAN. 

resents 38 per cent, of metallic mercury, with clari- 
fied honey and prepared chalk. 

Average dose: 0.25 gm. (4 grains). 

Massa Hydraegyri. — U. S. P. — Mass of Mer- 
cury, better known as blue mass, contains 33 per 
cent, of metallic mercury, with glycyrrhiza, althaea, 
glycerin and honey of roses. An analogous prep- 
aration without glycerin is frequently found in 
the shops under the somewhat incongruous title, 
"Powdered Blue Mass." 

Average dose: 0.25 gm. (4 grains). 

The mass of mercury and the mercury with 
chalk are widel}' used as mild mercurials and are 
especially popular for use with children. 

Being insoluble in water, they are not readily 
adapted for use in liquid form. Mixtures, of which 
the following formula is typical, are. however, used 
extensively for small children : 

IJ. MassjB hydrargyri 

Sodii biearbonatis, aa gr. xxx 2 

Syriipi rhei aromat. q. s. ad f^iii 100 

Misce. 

Sig. : Shake Avell. Give one-half or one teaspoonful 
from one to three times a day, according to age and 
condition of patient. 

Probably the most widely used as well as the 
most popular of all the preparations of mercury as 
an antisyphilitic is : 

Hydrargyri Iodidum Flavum. — U. S. P. — 
Yellow Mercurous lodid occurs as a bright yellow, 
amorphous powder, without odor or taste, and is 
practically insoluble in water and in alcohol. 

Average dose: 0.01 gm. (10 mg. or 1/5 grain). 

Hydrargyri Iodidum Eubrum.^U. S. P. — Eed 
Mercuric lodid occurs as a scarlet-red. amorphous 



ALTERATIVES. 129 

powder that is nearly insoluble in water, but sol- 
uble in 116 parts of alcohol ; it is also soluble in 
solutions of the soluble iodids and in solution of 
mercuric chlorid. 

Average dose: 0.003 gm. (3 mg. or 1/20 grain). 

Hydrargyri ChloridujM Corrosivum. — U. S. 
P. — Corrosive Mercuric Chlorid. more popularly 
known as corrosive sublimate, has been used by the 
Chinese from a very early period. It was used by 
the early Arabian physicians, and a process for 
its production was described by Geber in the eighth 
century. 

Mercuric chlorid occurs as colorless, rhombic 
crystals or crystalline masses, or, more frequently, 
as a white powder, and is odorless, but has an 
acrid and persistent metallic taste. It is soluble 
in about thirteen parts of water and in five parts 
of alcohol, more freely soluble in solutions of the 
alkaline chlorids. 

Average dose: 0.003 gm. (3 mg. or 1/20 grain). 

Hydrargyri Chloridum Mite. — U. S. P. — 
Mild Mercurous Chlorid, better known as calomel, 
has been known to some of the eastern peoples 
from a very early period. It appears to have 
been introduced in Europe about the beginning 
of the seventeenth century. This sul)stance occurs 
as a heavy white powder, without odor and prac- 
tically without taste, and is insoluble in water and 
in alcohol. 

Average dose as an alterative: 0.05 gm. (1 
grain). 

'i'lic IMi.iiiiiacopcia iiicliidcs several additional 
compuLuid.s ul mercury, but as they are not used 



i;50 PHARMACOPEIA AND PHYSICIAN. 

for internal administration tliey need not be enu- 
merated in this connection. 

USES OF MERCURIALS. 

Since the use of mercury as an alterative is 
largely limited to those conditions resulting from 
syphilis, either acquired or congenital, we shall at 
present confine ourselves to discussing its employ- 
ment in this way. 

The pathology of syphilis is very often so ob- 
scure that it should be treated by the specialist 
when possible, and the following is intended for 
the general practitioner who finds himself com- 
pelled to undertake the treatment of such cases. 

There are many distinct symptoms that are man- 
ifested by patients with a syphilitic history which 
fail to respond to the treatment which is commonly 
successful with persons otherwise healthy, but 
which at once disappear when mercury is given. 

Many authorities are opposed to any form of 
constitutional treatment for the first stage of 
syphilis because we have no specific capable of 
aborting the disease, and the treatment may mask 
or even prevent the appearance of those symptoms 
which render the diagnosis absolutely positive, 
without preventing the ultimate effects of the dis- 
ease, thus condemning the patient to the hardships 
of a long and painful course of treatment without 
positive knowledge of its necessity. Others rely 
on their ability to diagnose syphilis by the chancre 
and the history of the case, and proceed at once to 
the use of mercury. 

Inasmuch as it is supposed that mercury has 
comparatively little immediate influence on the 



ALTERATIVES. 131 

course of the disease at this time, -^-e should be 
very sure of the correctness of our diagnosis be- 
fore beginning a course of treatment which, to be 
effective, must be continued for many months, and 
is in itself not free from danger to the patient's 
health. 

All mercurials are irritant when dissolved and 
there are serious objections to all the different 
available methods of administration. Chief among 
these objections is the disturbance of digestion, 
which is not wholly obviated even when the mer- 
cury is injected hypodermically or applied by in- 
unction. 

Diarrhea is often a troublesome result, for which 
opium is sometimes used, but the evils attending 
its use are obvious and its presence should alwa3's 
be suspected in nostrums containing well-known 
mercurials that are advertised as being guaran- 
teed not to cause diarrhea or other gastric disturb- 
ances. Mercury is eliminated by all the channels 
of excretion and the kidneys not infrequently suf- 
fer serious injury. It follows that we must try to 
find the method best suited to the individual case, 
and attention is directed to the following means 
of administration with some of the objections to be 
guarded against or at least kept in mind : 

It is generally agreed that since there is no es- 
sential difference between the action of the various 
organic and inorganic salts of mercury in syphilitic 
conditions, we should be guided in our choice of 
agent by the method of administration which ex- 
perience teaches us to be best suited to the individ- 
ual case. If the digestion suffers from the internal 
administration of mercurials, intramuscular injec- 



132 PHARMACOPEIA AND PHYSICIAN. 

tions may be tried ; if these are too painful, inunc- 
tion may be resorted to; but whatever method is 
followed we must be alert for the appearance of 
untoward effects and the diet must be the object 
of especial attention, one being selected which is 
nutritious while it is easily digested. 

The mercurials are to be avoided or used only 
with great caution in cachexia due to other causes 
than syphilis, as their tendency to disturb diges- 
tion may increase the trouble. 

They must be used only with the greatest cau- 
tion in acute nephritis, but they seem to be less 
deleterious in the chronic form, though here, too, 
their action must be carefully observed. 

Mercury is particularly potent for harm in 
pregnancy, especially in the latter months; abor- 
tion may occur or the child may suffer from mer- 
curial poisoning. 

For internal use either mercurous or mercuric 
iodid is usually preferred. The combination of 
mercuric chlorid with potassium iodid merely 
means the giving of mercuric and potassium iodids, 
as the reaction occurs as soon as the two substances 
are brought into contact. When the mercuric 
chlorid is used it is best given alone in the form of 
a pill or in dilute solution, as it is incompatible 
with a great many substances. 

Mercuric chlorid may be given (really as mer- 
curic iodid) as follows : 

IJ. Hydrargyri ehloridi cor gr. iii 20 

Potassii iodidi gr. x 60 

Aquae dest., q. s. ad flSiii 100 

M. Sig. : Ten drops in water after each meal. In- 
crease each dose daily by one drop until symptoms of 
niereurialism are noted, then reduce to one-half. 



ALTERATIVES. 133 

This is not given as an example of the so-called 
mixed treatment, the dose of potassiimi iodid being 
entirely too small to be effective. 

An example of a prescription for mixed treat- 
ment would be as follows : 

IJ. Hydrargyri chloridi cor gr. i 05 

Potassii iodidi Siiss 10 

Aquse dest., q. s. ad flgiii 100 

M. Sig. : One teaspoonful after each meal. 

The object of giving the mercurials after meals 
is to insure the protection of the stomach, which 
the presence of food affords, against the irritant 
action of the metal. 

The menstruum or diluent for the prescription 
for mixed treatment may be varied in a number of 
ways. The water may be substituted by any one 
of the medicated waters, by adjuvant elixir, aro- 
matic elixir, compound tincture of gentian, com- 
pound syrup of sarsaparilla, or by a mixture of one 
or more of these vehicles; the most important 
point to be guarded against is the attempt to com- 
bine the potassium and mercuric iodid with alka- 
loids in solution, as the mixture of potassium and 
mercuric iodids is one of the most effective of pre- 
cipitants for alkaloids. 

The characteristic eft'ects of mercury are to be 
carefully watched for and when the gums become 
slightly tender the dose is to be reduced somewhat 
in amount and given but twice a day — after the 
morning and evening meals. It would be well to 
wash down the dose with milk, the proteid of 
which will serve to protect the stomach against 
the irritant action of the mercury, 

^lercurous iodid is not so corrosive as the mer- 
curic, or red iodid, and it is often given in pill 



134 PHARMACOPEIA AND PHYSICIAN. 

form with some colloidal substance, such as ex- 
tract of gentian. 

The following is an example of this method of 
giving it : 

IJ. Hydrargyri iodidi flav gr. vi 140 

Extracti gentianae gr. Ix 4| 

M. Fiant pilulse No. xl. 
Sig. : One pill after eating. 

This dose may be gradually increased by giving 
two pills after the mid-day meal, and then two 
twice, and finally three times, a day until the symp- 
toms of mercurialism mentioned above are seen. 
The dose is then reduced, as in the case of mer- 
curic iodid, and given after the principal meals. 

The mild mercurous chlorid, or calomel, may 
be used, but it is so insoluble that it is impossible 
to regulate the amount that is absorbed. Next to 
the administration of mercurials by the mouth, the 
intramuscular injection is to be preferred, but it 
causes great pain and may result in abscess forma- 
tion unless caution is observed. The addition of 
cocain hydrochlorid has been recommended by 
some authorities, but we should bear in mind the 
danger of forming a habit which is, if anything, 
even more terrible than syphilis. 

The injections should never be into or under the 
skin, but always deep, into the fascise, and should 
be made by the physician, as the patient can not be 
trusted to do it satisfactorily. 

Insoluble mercuric salicylate is not infrequently 
used for intramuscular injections and, by many 
specialists, is considered to be the best prepara- 
tion for this purpose. 

It is claimed that the local irritation is much 
less marked and that abscess formation is much 



ALTERATIVES. 135 

less frequent. Mercuric salicylate is given sus- 
pended in oil or liquid petrolatum of such a 
strength that 0.6 c.c. (10 minims) represent 0.06 
gm. (1 grain). The injections are usually given 
in the buttocks, care being taken that the same area 
is not selected for consecutive injections. 

The first dose is usually 0.03 gm. (% grain) 
given once or twice a week, and this is increased 
slowly to 0.10 gm. (1% grains) or until the de- 
sired effect is obtained. 

The advantages that are claimed for the injec- 
tion of the insoluble salt are its slow absorption, 
the prevention of salivation, the accurate regula- 
tion of the dose and the more perfect control of the 
patient. 

The inunction method is very commonly em- 
ployed in the establishments at Hot Springs, Ark., 
where many syphilitics are treated. 

The inunction may be done as follows: After 
inducing diaphoresis, 3 grams (about 45 grains) 
of mercurial ointment are rubbed into the skin, not 
merely on it, daily. As this must be applied to a 
rather large extent of surface it is customary to 
select six regions which are utilized on successive 
days, returning on the seventh day to the first 
region. These arc the adductor surfaces of the 
thighs (the most convenient when the patient is 
to rub the ointment into his person), the armpits 
and the regions just below, extending anteriorly, 
and the subscapular regions of each side. 

The ointments of the oxids of mercury and tlie 
oloate of mercury arc more irritant than the mer- 
curial ointment or the blue ointment, as the di- 
hited mercurial ointment is now called. 



136 PHARMACOPEIA AND PHYSICIAN. 

Too much stress can not be placed on the neces- 
sity of giving- close attention to the various bodily 
functions during the mercurial treatment, to main- 
tain the appetite and digestion unimpaired, to reg- 
ulate the bowels and to secure scrupulous cleanli- 
ness of the body. The mouth should be the object 
of especial attention; carious teeth should be filled 
and the mouth and teeth kept thoroughly cleaned. 
The systemic action of iodin and the iodids is very 
similar and they may be considered together. 

The use of iodin and the iodids, like that of 
mercur}'-, i§ well established on clinical evidence 
and we can only speculate as to the way in which 
it produces its effects in syphilis, chronic rheuma- 
tism and asthma, but the symptoms induced by 
their use require consideration. 

Iodin, and more frequently the iodids, give rise 
to iodism; this occurs under very variable condi- 
tions. It may be induced by very small doses of 
any iodid, but disappear even when the dose is 
increased, or it may appear only when a certain 
amount is exceeded. The symptoms vary in in- 
tensity from a slight catarrh of the respiratory 
passages to grave, and even rarely fatal involve- 
ment of the larynx. The throat, tonsils and sali- 
vary glands are often affected, and a brassy taste 
in the mouth may be the first symptom observed 
by the patient. Headaches may occur, the eyes 
become inflamed and various skin eruptions ap- 
pear. 

The iodids are decomposed in the tissues to a cer- 
tain extent, and it is probable that the symptoms 
of iodism may be explained by the irritant action 
of the liberated iodin, and it has been suggested 



ALTERATIVES. 137 

that this liberated iodin also destroys the gimima 
occurring in syphilis. 

Iodin and the iodids may cause nausea from the 
local irritant act;on in the stomach. They cause 
an increase in the iodothyrin of the th3^roid gland, 
and this may explain their beneficial action in 
simple enlargement of the thyroid (goiter) as well 
as the untoward symptoms which sometimes follow 
its use in that affection, since the iodothyrin 
formed may suddenly liberate an unusual amount 
of the glandular secretion. 

The mode of action of the iodids on the elimina- 
tion of- lead and mercury from the tissues is un- 
known, nor can we explain their action in aneur- 
ism, for it is not true that they slow the circula- 
tion of the blood by their action on the heart or by 
dilating the vessels. 

The iodids are extremely diffusible and very soon 
after being taken they appear in the urine and 
other excretions and secretions of the body. 

It has been suggested that a deficiency of thyroid 
secretion may sometimes predispose to aneurism 
and that the action of the iodids is dependent on 
their effects on that gland, but syphilis is known 
to be an extremely common antecedent to aneur- 
ism and that probably is the commonest explana- 
linii of the action of the ioilids in that condiiion. 

OFFICIAL PKEPARATIONS. 

loDUM. — U. S. P. — Iodin occurs in hhiisii-hhick 
rhombic plates that have a metallic luster, a dis- 
tinctive odor and a sharp and acrid taste. It is 
only slightly soluble (1/5000) in water, but is 
readily soluble in ton parts of alcohol. It is also 



138 PHARMACOPEIA AND PHYSICIAl^. 

soluble in an aqueous solution of potassium, or of 
sodium, iodid. 

lodin was discovered about 1812 by Courtois, 
a French manufacturing chemist, but it was not 
used in medicine until after 1820. 

Average dose: 0.005 gm. (5 mg. or 1/10 grain). 

Liquor Iodi Compositus. — TJ. S. P. — Com- 
pound Solution of lodin contains 5 per cent, of 
iodin and 10 per cent, of potassium iodid in dis- 
tilled water. 

Average dose: 0.20 c.c. (3 minims). 

TiNCTUEA Iodi. — U. S. P. — Tincture of lodin, 
as now official, represents an alcoholic solution of 7 
per cent, of iodin and 5 per cent, of potassium 
iodid. The resulting tincture is freely miscible 
with water and with alcohol. 

Average dose: 0.10 c.c. (IV2 minims). 

AciDUM Hydriodicum Dilutum. — U. S. P. — 
This is a new addition to the Pharmacopeia and is 
intended primarily for the preparation of the 
syrup of hydriodic acid. It should contain not 
less than 10 per cent, by weight of the absolute 
acid. 

Average dose: 0.50 c.c. (8 minims). 

Syeupus Acidi Hydriodici. — U. S. P. — This is 
a clear, colorless, syrupy liquid that contains about 
1 per cent, of absolute hydriodic acid. 

Average dose: 4 c.c. (1 fluidram). 

Syrup of hydriodic acid is designed to be freshly 
prepared and the official requirements insure a 
uniformly elegant and efficient preparation. 

Syrupus Ferri Iodidi. — U. S. P. — This syrup, 
in harmony with the Brussels conference agree- 



ALTERATIVES. 139 

ment, now contains about 5 joer cent, by weight, 
of ferrous iodid. 

Average dose: 1 c.c. (15 minims). 

The official salts of iodin are ali freety soluble 
in water and are also soluble in alcohol and alco- 
holic liquids. The}- are, in the order of their pop- 
ularity and use: 

PoTASsii IoDiDu:\r. — TJ. S. P. 

SODII lODIDU^I. — U. S. P. 

Stuoxtii loDiDUii. — U. S. p. 

Average dose of any of the above : 0.50 gm. 
(Ti/2 grains). 

Ammonii Iodidu^i. — U. S. P. 

Average dose: 0.25 gm. (4 grains). 

While mercury is employed in all stages of 
syphilis, but is most useful in the second stage, 
the iodids are employed in the second and third 
stages, but find their greatest field of usefulness 
in the third. The iodids enjoy a peculiar reputa- 
tion in the treatment of those symptoms of tertiary 
syphilis, such as periostitis, which are manifested 
in connection with the bones. 

Potassium iodid is sometimes used in enormous 
doses — 50 to Go grams (800 to 1,000 grains) daily 
— in gumma of the brain and in cerebral syph- 
ilis, in whicli prompt action is necessary, the effect 
at times being truly remarkable in tbe promptness 
with which the symptoms improve. 

Bronchitis, in those who suffer with a rheumatic 
or gouty diathesis, often shows greater improve- 
ment under the influence of this drug than with 
any other treatment. 

The iodids arc rarely used alone in the second 
stage of syphilis, Ijut in combination with mercury, 



140 PHARMACOPEIA AND PBYSIGIAN. 

known as the mixed treatment, already referred to, 
they appear to be" of value. 

The saturated solution of potassium iodid is, 
perhaps, the form of administration most com- 
monly used. 

The preparation of this may be entrusted to the 
pharmacist or it may be ordered as follows : 

B. Potassii iodidi ^i 301 

Aquae dest. q. s. ad f^i 30 1 

M. Ft. solut. 

Sig. : Five drops after each meal, the dose to be in- 
creased by one drop each day. 

The increase in the amount to be taken may be 
continued until the symptoms of iodism arise or 
until sixty drops or more are taken daily. 

The patient is to be instructed as to the symp- 
toms to be expected, such as pain in the region of 
the parotid gland, etc. 

The appearance of mild symptoms of iodism is 
not always the signal for stopping the iodids, as 
they may disappear if the dose is diminished and 
at times even when increased if this previously has 
been small. The symptoms of iodism nearly al- 
ways disappear promptly when the iodids are with- 
drawn. 

The iodids are often useful in the greatest va- 
riety of conditions occurring in syphilitics, or those 
with a syphilitic history, and their use should also 
be borne in mind always when such patients are 
being treated. 

It is of little consequence whether we choose 
potassium iodid or one of the other inorganic 
iodids or an organic preparation. Potassium iodid 
has long been the most popular of all of the avail- 



ALTEIiATITES. 141 

able preparations and will probabh- continue to be 
the most nseful or, at least, the most frequently 
used. 

THYROID GLAXD. 

The removal of the thyroid glands gives rise to 
certain symptoms like those seen in myxedema ; it 
is evident that these sj-mptoms are due to a defi- 
ciency in some glandular secretion, and it was soon 
found that myxedema could be successfully treated 
by the administration of thyroid in various ways. 
The active sul)stance resists digestion and it was 
not long before its isolation was accomplished. It 
proved to be a non-proteid compound containing 
variable amounts of iodin according to the process 
of preparation. This iodin compound, called iodo- 
thyrin, probably represents fully the therapeutic 
activity of the gland. 

Small doses of the gland or of iodothyrin have 
no effect on many normal individuals, but they 
sometimes cause disagreeable symptoms; these are 
more common in persons suffering with myxedema, 
palpitation of the heart being among the most 
common of these symptoms. 

Iodothyrin, is said to cause a fall of blood pres- 
sure when it is injected into a vein, but it is denied 
that the blood pressure is affected at all when 
iodothyrin or the gland sub.'^tanco is taken in the 
stomach. 

Tliyroid rcc(ling causes a loss of weight in myxo- 
doina, and as a I'ule wlien first used for obesity, 
though tlie beneficial effects are usually tempoi-ary 
in the latter affection. This loss of weight is at- 
tributable in part to a destruction of fat, and in 
part to do.«trnr'tion of protcid. 'I'lic |i;iticnt (■;in 



142 PHARMACOPEIA AND PHYSICIAN. 

be kept in nitrogen equilibrium while losing weight 
by a diet consisting largely of meat or other pro- 
teid. Thyroid feeding also causes diuresis and a 
part of the loss in weight may be attributed to the 
water separated from the tissues. 

GlANDUL.T] ThYROIDE^. SiCGiE. — U. S. P. — 
Desiccated thyroid gland is officially described as 
"the 'cleaned, dried and powdered thyroid glands 
of the sheep, freed from fat." It occurs as a yel- 
lowish amorphous powder, having a peculiar odor; 
it contains the active ingredients of the thyroid 
tissue. It is partially soluble in water. 

Average dose: 0.25 gm. (4 grains). 

Thyroid gland or iodothyrin is indicated in 
obesity, after removal of the thyroid or when the 
latter, through disease, fails to function properly, 
as in myxedema and in hypoplastic follicular goi- 
ter, but they must be used cautiously in myxedema, 
particularly when the heart becomes rapid and 
weak. 

While they have been said to act beneficially in 
some cases of exophthalmic goiter, they usually 
augment the symptoms, and must be used only 
with extreme caution if at all. 



CHAPTEE YI. 

STOMACHICS. 

In this group are included a number of agents, 
many of them used for centuries, with actions 
scarce!}- better understood now than they were in 
the remote past. They include those agents com- 
monly called bitters and aromatics, terms which 
refer only to taste, or, to be more accurate in the 
case of aromatics, to taste and smell, but which 
are employed as therapeutic terms for want of 
better, thus suggesting how little we know of their 
mode of action. Despite this want of exact knowl- 
edge of their pharmacologic action, the accumu- 
lated clinical evidence of 2,000 years or more goes 
to show that they are useful in slight catarrhal 
conditions and in minor functional disturbances 
of the alimentary canal in which there are no seri- 
ous anatomic changes. 

It is possible that their beneficial influence is 
sometimes due in part to the psychic effect, as they 
are agreeable to many tastes, and their regular use 
may encourage tlio patient — two iin])ortant factors 
in digestion. 

IMost of the cxperiiiicnts ilial liaxc hithri'to l)ccii 
conducted Avitli these a,ucn(s have been iiindc on 
animals, and Ihc results liave been variable and 
ofjeii e(int i-;i(licl<)i'y. lienee we must depend nlniosl 



144 PHARMACOPEIA AND PHYSICIAN. 

Owing to the great variability of the functions 
involved and the natural discrepancy in the capa- 
bility of various observers, most inaccurate conclu- 
sions have been reached, and, therefore, no attempt 
can be made to give precise information as to the 
exact relative merits of one member rather than 
another in a given condition. 

That the taste of bitter substances excites the 
flow of saliva is a matter of common experience, 
and the bitter taste in the mouth of the dog has 
been found to cause a prompt, but not long-con- 
tinued secretion of gastric juice. It is, therefore, 
advisable that bitter stomachics be taken, in liquid 
form, only a few minutes before eating. Bitter 
substances in pill form pass into the stomach with 
but little action on the latter organ and have little 
direct influence on the appetite. 

After therapeutic doses of the simple bitters 
have reached the stomach they can hardly exert 
any perceptible effect directly on the activity of 
the gastric juice, and this extremely slight effect, if 
adverse, would be very much more than counter- 
balanced by the increased amount of the secre- 
tion, but excessive amounts of the bitters may 
retard digestion. 

While a large number of official substances are 
used as simple bitters or stomachics, it will not be 
necessary to enumerate more than a few of the 
more popular to illustrate the variety of this class 
of drugs. 

Gentiana. — U. S. P. — The dried rhizome and 
roots of Gentiana lutea, constitute by far the best 
known and the most widely used of all simple bit- 
ters. This drug is not alone of interest medicin- 



STOMACHICS. 145 

ally, but it has also taken an important part in the 
folklore, traditions and legends of European peo- 
ples. It is said to have been introduced into med- 
icine by Gentius, King of Illyria, who discovered 
its medicinal virtues. 

Fluidextractum Gentians. — U. S. P. — This 
is made with diluted alcohol. 

Average dose: 1 c.c. (15 minims). 

ExTRACTUM GENTiANiE. — U. S. P. — This is an 
aqueous extract of gentian evaporated to pilular 
consistence. 

Average dose : 0.25 gm. (4 grains) . 

TiNCTURA Gentian.^ Composita. — U. S. P. 
— This represents 10 per cent, of gentian, 4 per 
cent, of bitter orange peel and 1 per cent, of car- 
damom in GO per cent, alcohol. 

Average dose: 4 c.c. (1 fluidram).^ 

Calumba. — U. S. P. — The dried root of Jateor- 
hiza palmata, was introduced into Europe by the 
Portuguese in the seventeeth century and has been 
much employed as a simple bitter since that time, 
particularly on the continent of Europe. 

1. The compound tincturo of gontian is probably the most 
popular of all stomachies and is widely used either alone or 
in combination with a mild antacid, such as sodium bicar- 
bonate. A mixture that is largely used, particularly in hos- 
pital practice, may be compounded somewhat as follows: 

R. Tinct. Rent, comp 3x 401 

Sodii bicarbonatls gr. xc G 

Aqutc q. s. ad Slii 100 1 

To be given in doses of 2 or 3 teaspoonfuls before meals. 

Sucli a prescription, of course, may be varied in innumer- 
able ways, the addition of compound tincture of cardamom 
will not alone Improve its appearance, but will also make it 
much more acceptable, in that It makes the whole mixture 
more aromatic. The addition of tincture of capsicum, 0.2 c.c. 
or 0..'5 c.c. (3 to r> minims) to each dose, makes the mixture 
sharp and pungent and may be desirable, particularly In 
cases of alcoholic gastritis. 



14G PHARMACOPEIA AND PHYSICIAN. 

Fluidextractum Calumb.'e. — U. S. P. — This 
is made with 70 per cent, alcohol. 

Average dose: 2 c.c. (30 minims). 

TiNCTUEA CALUMBiE. — U. S. P. — This repre- 
sents 20 per cent, of the crude drug. 

Average dose: 4 c.c. (1 fiuidram). 

Quassia. — U. S. P.- — The wood of Picarasma 
excelsa — Jamaica quassia or of Quassia amara — 
Surinam quassia, appears to be more popular in 
England than in this country. Tlie official prepa- 
rations are : 

Fluidextractum Quassi^e. — U. S. P. — This is 
made with 33 per cent, alcohol. 

Average dose: 0.5 c.c. (8 minims). 

ExTRACTUM Quassia. — U. S. P. — This is an 
aqueous extract of quassia, representing ten times 
its weight of the crude drug. 

Average dose: 0.05 gm. (1 grain). 

TiNCTUEA QuASSi.^i;. — U. S. P. — This represents 
20 per cent, of quassia in 35 per cent, alcohol. 

Average dose: 2 c.c. (30 minims). 

Two other drugs which are frequently used by 
American physicians are chirata and berberis. 

Chirata. — TJ. S. P. — The dried plant of Sioer- 
tin cliirayita is a comparatively recent addition to 
European medicine, though it has long been used 
and held in high esteem by the Hindus. The only 
official preparation in our Pharmacopeia is : 

Fluidextractum Chirata. — U. S. P.— This is 
made with diluted alcohol. 

Average dose: 1 c.c. (15 minims). 

Berberis. — U. S. P. — (Barberry) — The rhiz- 
ome and roots of BerheKis aqnifoliuni. 



STOMACHICS. 147 

Fluidextractum Berbekis. — JJ. S. p. — This is 
made with diluted alcohol. 

Average dose: 2 c.c. (30 minims). 

aeo:matics. 

Aromatics contain volatile oils, on which they 
depend for their flavor and for a slightly irritant 
action on the mucous membranes. Brandl found 
tliat the irritation and the consequent hyperemia 
of the mucous membrane of the alimentary canal, 
due to sharp tasting substances, caused increased 
absorption of certain products of digestion. As 
the aromatics usually have an agreeable taste, they 
])robaljly increase gastric secretion by reflex stimu- 
lation, but it has not been demonstrated that they 
increase the amount of hA'drochloric acid or of the 
digestive ferments. 

All volatile oils have an antiforment action, and 
the aromatics. therefore, may lessen gastric fer- 
mentation. 

The slightly irritant effect, with the hyperemia, 
must be the main factors in their effects on diges- 
tion after that of reflex "stimulation. 

In this connection it is to be remembered that 
nau.sca. pain in the stomach and other symptoms 
of functional disturl)ances of tlio gastrointestinal 
canal are often promptly relieved by external ap- 
])licatioii of heat or even l)v a inustni'd footbath. 
whicli can only act reflexly. 

It is easy to understand why pine aii' and inter- 
esting surroundings play such an important role 
in appetite and digestion wlicii we consider how 
com|>let<'ly those functions aiv iimh'i- (he control 
of the reflexes, mere change of local ion heiiig much 
less im|)orlant than the suhslii nl ion of inleresl in--. 



148 PHARMACOPEIA AND PHYSICIAN. 

for monotonous, siiri-oundings, and in advising 
change of scene with outdoor life these details 
can not ))e too carefully considered. 

The official aromatic bitters include : 

Calamus.— U. S. P.— (Sweet Flag).— The 
dried rhizome of Acorus calamus was known to the 
ancients and is still largely used in Europe, though 
not so popular in this country. 

Pluidextractum Calami. — U'. S. P. — This is 
made with 75 per cent, alcohol. 

Average dose: 1 c.c. (15 minims). 

AuEANTii Amaei Cortex. — U. S. P. (Bitter 
Orange Peel). — -The dried rind of the unripe fruit 
of Citrus vulgaris has long been used as an aro- 
matic bitter, but is chiefly used as an addition to 
other drugs, as in the compound tincture of gen- 
tian and the compound tincture of cinchona. ■ 

Pluidextractum Aurantii Amari.— IT. S. P. 
— This is made with 65 per cent, alcohol. 

Average dose: 1 c.c. (15 minim.g). 

TiNCTURA Aurantii Amari. — U. S. P. — This 
represents 20 per cent, of the crude drug and con- 
tains 60 parts of alcohol. 

Average dose: 4 c.c. (1 fluidram)._ 

ASTRINGENT BITTERS. 

Drugs that might properly be classed as astrin- 
gent bitters are numerous, and, therefore, we shall 
enumerate but a few of the more important. 

CiMiciFUGA. — U. S. P. — The dried rhizome and 
roots of Cimicifiiga racemosa, a plant that is a na- 
tive of North America, have been used extensively 
in some sections of the United States. 



t 



,S'rOiIACHICS. 149 

Fluidextractu:\i Cimicifug-^. — U. S. P. — 
This is made with strong alcohol. 

Average close: 1 c.c. (15 minims). 

TiNCTURA CiMiciFUGiE. — U. S. P. — This is. 
made with alcohol. 

Average dose: 4 c.c. (1 fluidram). 

Serpentaria. — U. S. P. — The rhizome and roots 
of Arlstoloclna serpentaria, popularly known as 
Virginia snakeroot. have been used in Europe for 
over 200 years. 

FlUIDEXTRACTUM SERPEXTARIaTl. — U. S. P. — 

This is made with 80 per cent, alcohol. 

Average dose: 2 c.c. (30 minims). 
. TiNCTCRA Serpentari^. — U. S. P. — This rep- 
resents 20 per cent, of the crude drug and is made 
with a menstruum containing G5 parts of alcohol. 

Average dose: 4 c.c. (1 fluidram). 

Hydrastis. — U. S. P. — The rhizome and root- 
lets of Hydrastis caruidensis. a perennial plant that 
is indigenous to Canada and the United States east 
of the Mississippi Eivcr. 

Fluidextractu.m Hydrastis. — U. S. P. — This 
is made with a menstruum containing 60 parts of 
alcohol, with glycerin and water, and should con- 
tain not less than 2 ])er cent, of hydrastin. 

Average dose: 2 c.c. (30 minims). 

Tikctura Hydrastis. — ^tJ. S. V. — This wprc- 
scnts 20 per cent, of the crude diiig nnd is made 
with 65 per cent, alcohol. 

Average dose: 4 c.c. (1 iluidrain). 

CiNCiioxA.— U. S. P.— While undoni)((>,llv l.d- 
tor known and more extensively used as a bitter 
stomachic than any of the preceding, it is unneces- 
sary to rcfoiint the origin or the uses of this drug. 



150 PHARMACOPEIA AND PHYSICIAN. 

It is official under two titles : Cinchona and Cin- 
chona Eubra. Of the former we have : 

Fluidextractum CiNCHONiE. — U. S. P. — This 
is made with 80 per cent, alcohol and contains 4 
per cent, of the ether-soluble alkaloids of cinchona. 

Average dose: 1 c.c. (15 minims). 

TiNCTUEA CiNCHONvE. — U. S. P. — This repre- 
sents 20 per cent, of the crude drug and should 
contain 0.75 per cent, of cinchona alkaloids. 

Average dose: 4 c.c. (1 fluidram). 

The only official preparation of red cinchona is 
the old, and still popular, Huxham's tincture of 
bark. 

TiNCTURA ClNCHON.^ COMPOSITA. — U. S. P. — 

This represents 10 per cent, of red cinchona, 8 
per cent, of bitter orange peel and 2 per cent, of 
serpentaria. 

Average dose: 4 c.c. (1 fluidram). 

Nux Vomica. — U. S. P. — The dried ripe seed of 
Stnjchnos mix vomica, although not containing 
sufficient tannin to be classed as an astringent bit- 
ter, forms an inky mixture when iron is added to 
it. It is frequently used as a bitter stomachic. The 
available preparations are: 

Fluidextractum Xucis Vomica. — U. S. P. — 
This contains 1 per cent, of strychnin. 

Average dose: 0.05 c.c. (1 minim). 

TiNCTUEA Nucis VoMicai:. — IJ. S. P. — This 
contains 2 per cent, of extract of nux vomica and is 
assayed to contain 0.1 per cent, of strychnin. 

Average dose: 0.6 c.c. (10 minims). 

Bitters, and more particularly the aromatic bit- 
ters, are indicated in loss of appetite when it is not 
due to ofrave o-astric disturbances. AVhen catarrh 



STOMACHICS. . i^l 

of the gastric mucous membrane complicates the 
condition, an astringent bitter, such as serpenta- 
ria, cimicifiiga or cinchona, should be used. In the 
absence of catarrh, indigestion accompanied by in- 
sufficient gastric secretion, ma}- be treated with a 
simple bitter, such as gentian or calumba, which 
may be used alone, but it is very much more often 
advisable to combine the simple bitters with aro- 
matics. 

The individual taste of the patient should al- 
wa3's be considered in the choice of the aromatic. 
Men often like simple bitters, such as gentian or 
gentian and orange, a fact attested by the extraor- 
dinary popularity a few years ago of a certain bit- 
ters, which consisted practically of compound tinc- 
ture of gentian. Women usually prefer mildly aro- 
matic and not very bitter substances, while chil- 
dren are generally averse to them altogether. 

When excess of acidity exists bitter substances 
will probably increase the trouble. Just as bitters 
and aromatics produce a greater effect in cases of 
functional disturbances. 50 iron is useful in ane- 
mia, though it has little influence in health, and it 
is often found advisable to combine iron with bit- 
ters, in which case the astringents are to be avoided 
because of the chemic reaction, whereby an inky 
mixture is formed, disagreeable alike to sight and 
taste — two groat ol)jections in this class of reme- 
dies. 

^fany Ijittcr.s wliic-li iin; ikjI usually classed as 
astringents contain enough tannin or similai-ly aci- 
ing substances to give inky mixtures willi fei-i'ic 
sails: siicli. \nv instance, are genlian am! mux 
vomica. Calumlni, therefore, is to be given the 



152 PHARMACOPEIA AND PHYSICIAN. 

preference in all cases in which a bitter is to be 
combined with a soluble salt of iron. Detannated 
preparations of cinchona and even solutions of the 
cinchona alkaloids have little to recommend them 
in preference to calumba as a simple bitter. 

The following illustrates the combination of a 
simple bitter with iron: 

IJ. Tinct. calumbse giii lOO 

Tinct. ferri chloridi m. Ixxv 5 

Aquae q. s. ad gvi 200 

M. Sig. : A tablespoonful may be given half an hour 
before meals to men, while a teaspoonful will usually 
suffice for women.- 

The possible combinations of aromatic liitters 
are infinite, and, as previously stated, the indi- 
vidual taste is to be considered rather tlian slavish 
adherence to any one formula. 

For an astringent bitter the fluid extract or the 
tincture of cinchona, cimicifuga or serpentaria 
may be combined somewhat as follows : 

IJ. Fluidextract cinchonfe I 

Tinct. gentianse comp., aa 3xii 501 

M. Sig.: .One teaspoonful to be given before meals. 

For women it will be well to increase the amount 
of aromatics, in which case the compound tincture 
of cardamom may be substituted for the compound 
tincture of gentian and the mixture even further 
diluted with aromatic elixir, if thought desirable, 
as follows : 

IJ. Fluid extract, cinchonse 3v 20| 

Tinct. cardamomi comp. I 

Elixir aromatici, afi 3x 40] 

M. Sig.: One teaspoonful of this mixture with water, 
to be given before meals. 

2. While small closes of iron, well diluted, may be given 
with bitters before meals, if larger closes are given after 
eating they are borne better than they would be if given on 
an empty stomach. 



STOMACHICS. 153 

A mixture of nux vomica and sodium bicarbon- 
ate offers a number of advantages as an efficient 
and comparatively barmless stomacbic. It is made 
as follows : 

IJ. Tinct. nucis vom m. Ixxv 5] 

Sodii bicarb gv. el 10 

Aquae dest q. s. ad gv 150 1 

Altbougb tecbnically tbis formula involves an 
incompatibility — sodium bicarbonate and the alka- 
loids of nux vomica — practically it is very satisfac- 
tory indeed. If the mixture is filtered and allowed 
to stand for 24 hours before being dispensed it will 
be found to have developed a very pleasant ethereal 
odor that adds materially to its effectiveness. The 
usual dose for adults is one tablespoonful before 
meals. For a patient with chronic constipation the 
addition of 1 or 2 c.c. (15 to 30 minims) of the 
fluidextract of cascara sagrada will be found to be 
highly satisfactory. One argument in favor of 
this combination is that it contains little alcohol — 
virtually none. 

CARMINATIVES. 

The origin of this word is in doubt, some au- 
thorities maintaining that it comes from carmen, a 
charm, and the term is even now used somewhat 
loosely for those agents which produce a sense of 
warmth and well-being and Avhich act as antispas- 
modics, or which expel gases from the gastrointes- 
tinal canal. Wbcn given with cathartics tbey 
lessen the griping ])ain of tlicsc drugs, and. being 
antis('j)tic, tliey inliilni the foniiiilion of gas by 
I'ennentatioii. 

According to the accepted dcliiiilion ;i unalrr or 
less numbf'r of snl)stanees can be iiichuled in Ibis 



154 PHARMACOPEIA AND PHYSICIAN. 

particular class. The official carminatives afEord a 
very wide range of choice, as the}^ include practi- 
cally all aromatic bitters, nearly all the aromatic 
volatile oils, besides such substances as ginger and 
capsicum, which contain pungent resinous constitu- 
ents, alcohol, ether, chloroform and many other 
agents which produce a sense of warmtli when swal- 
lowed. 

Carminatives are among the most ancient of rem.- 
edies and are indicated in pain in the stomach or 
bowels when due to simple indigestion or disten- 
sion by gas, but not when there is inflammation; 
in the latter case — for instance, in appendicitis oi 
in peritonitis — carminatives are apt to augment 
the trouble. 

Many of these substances are well known as 
household remedies and it will suffice to enumerate 
only the more important ones. 

Zingiber. — U. S. P. — Ginger has been used 
from time immemorial in eastern Asia ; it was well 
known to the ancient Greeks, and is even now, 
perhaps, the most popular of all the carminatives. 
The most widely used of the official preparations is 
the tincture. 

TiNCTUEA ZiNGiBERis. — U. S. P. — This repre- 
sents 20 per cent, of the crude drug exhausted with 
alcohol. 

Average dose: 2 c.c. (30 minims). 

Fluidextractum Zingiberis. — U. S. P. — This 
is an alcoholic extract. 

Average dose: 1 c.c. (15 minims). 

Oleoresina Zingiberis. — U. S. P. — This is 
now prepared by means of acetone. 

Average dose: 0.03 gm. (% grain). 



STOMACHICS. 155 

Half a teaspoonful of the tincture may be given 
in a little hot water or with sugar. 

The oleoresin is much more active, and a drop 
of it may be thoroughly well mixed with powdered 
sugar and from one-eighth to one-fourth of the 
quantity given to a child, but not to an infant. It 
may also be added in half-drop doses or less to 
bulky cathartic pills or mixtures, but in either case 
it should be well diluted. 

While ginger is very commonly used alone as 

just mentioned, it may be prescribed somewhat as 

follows : 

IJ. Tinct. zingiberis 3iv 16 

Chloroformi 3i 4 

Elixir aromat. q. s. ad giii 100 

M. Sig. : One teaspoonful thirty minutes after eating. 

Capsicum. — U. S. P. — Capsicum has been in 
use as a condiment, in eastern countries, from a 
very early period. It is intensely pungent and is 
particularly useful in cases of alcoholic gastritis. 

Average dose: 0.05 gm. (1 grain). 

TiNCTDRA Capsici. — U. S. P. — Tiucture of 
Capsicum represents 10 per cent, of the drug in 90 
per cent, alcohol. 

Average dose: 0.5 c.c. (8 minims). 

Fluidextractum Capsici. — U. S. P.— Fluidex- 
tract of capsicum is directed to l)c made with 
strong alcohol. 

Average dose: 0.05 c.c. (1 minim). 

Oleohesina Capsici. — U. S. P. — Is directed to 
be made by using acetone as the solvent. 

Average dose: 0.030 gm. (30 mg. I/2 grain). 



15G PHARMACOPEIA AND PHYSICIAN. 

THE OFFICIAL MIXTS. 

Of the large number of aromatic drugs of the 
mint famil}', two have attained more than ordinary 
popularity as carminatives. The revisers of the 
Pharmacopeia have, indeed, been impartial in their 
description of these two substances and have 
treated them absolutely alike, so that from their 
status as official drugs it would be difficult to say 
whether peppermint or spearmint should be ac- 
corded the preference. It wall be safe to assert, 
however, that peppermint is the more widely used. 
It is official as : 

Mentha Piperita. — U. S. P. (Peppermint). — 
The dry leaves and flowering tops. 

Average dose: 4 gm. (1 dram). This is some- 
times used in infusion. 

Oleum Mentha Piperit.f:. — U. S. P. — This is 
a volatile oil distilled from the fresh and partly 
dried leaves and flowering tops of peppermint. 

Spiritus Mentha Piperit.^. — U. S. P. — This 
is an alcoholic solution of 10 parts of oil of pepper- 
mint filtered through 1 part of bruised pepper- 
mint, W'hich imparts to it a distinct greenish color. 

Average dose: 2 c.c. (30 minims). 

Aqua Menth^e Piperit^e. — U. S. P. — This is a 
saturated aqueous solution of oil of peppermint. 

Average dose: 15 c.c. (4 fluidrams). 

As above noted, spearmint, Mentha viridis, is 
official under corresponding headings and the doses 
are. of course, the same. 

The uses of these official mints are too numerous 
and too well known to require description in detail. 
They appear to be particularly useful in gastric 
fermentation, for which purpose they are usually 



STOMACHICS. 157 

given in connection with a mild alkali, like sodium 
bicarbonate, preferably in the well-known mixture 
of soda mint of the National Formulary or the 
widely used soda-mint tablets.'^ 

Accumulations of gas in the stomach which 
prove most distressing can often be promptly re- 
lieved by administration of 20 grains of sodium 
bicarbonate or potassium l)icarbonate dissolved, 
preferably in hot water, to which from 10 to 30 
drops of spirit of peppermint or spearmint may be 
added. 

ASAFETIDA. 

AsAFG-TiDA. — T^. S. P. — A gum resin obtained 
from the root of one or more species of Ferula, 
was held in iiigli esteem l)y the ancient Greek 
physicians and has been in general use since that 
time. 

x\verage dose: 0.25 gm. (4 grains). 

PiLULiE AsAFCETiD.ii:. — U. S. P. — Eacli pill con- 
tains 0.2 gm. (3 grains) of asafetida and O.OG gm. 
(1 grain) of soap. 

Average dose : 2 pills. 

TiNCTURA AsAFGiTiDiE. — U. S. P. — This repre- 
sents 20 per cent, of asafetida in alcohol. 

Average dose: 1 c.c. (15 minims). 

3. The Mistura Sodse et Menthoe of the National Korimi- 
hu-y consist.s of : 

Sodium Ijicnilidiialc grs. Ixxv .")! 

Aromatic spirit of aiiiMioiiia m. xv 1 

Spi-armliit water to inMJjr r,iii I()(i[ 

Mix and liltcr. 

Tlic average dosi' ol" lliis |ii-c|i;ir:i I icn is rmin :.' In :; {i-.\ 
spooiifuis. 

Soda mint tal)lcls as fiiriiislu'd l.y iii;i iinl:irl iin'rs nsnall.v 
POHhIhI of d.."! Kill. (.'> ni-;iiiisi (if soilluiii liic;irl)(ilialf wilii 

().()<)•_' (i;:',i) iiiiiiiiii) ..r oii ,,r |,r|,|„.iijiini. 



158 /'IIA/niA<U)PKIA AXD pnYSICIAN. 

EMULsr:\r AsAFn;TiD.T:. — I^. S. P. — Tliis repre- 
sents 4 per eeiit. of asafetida in water. 

Average dose: 15 c.c. (4 fluidrams) . 

As an addition to other carminatives, asafetida 
in substance was at one time very popular. At 
present it is not often administered in any form 
other than suppositories. These are largely used 
after surgical operations to overcome the atony 
and partial paralysis that frequently accompanies 
surgical interference in the abdomen. 

The emulsion is used extensively, as a clyster, to 
relieve accumulations of gas in the intestines, after 
alidominal operations. It was at one time a very 
popular remedy for colic in infants, but the nause- 
ous taste makes it very disagreeable and the greater 
number of infantile complaints, in which it might 
be indicated, are much more effectively treated 
with a laxative such as castor oil or magnesia, and 
by the application of warmth to the abdomen. 

The Xational Formulary contains a number of 
carminative mixture?. Among the better known 
are: Mistura Carminativa, or Dalby's Carminative, 
containing about three drops of tincture of opium 
in the ordinary teaspoonful ; Mistura Chloroformi 
et Cannabis Indict Composita. which, in addition 
to Cannabis Indica, contains one and one-eighth 
grains of morphin sulphate to the fluid ounce, 
chloroform, ether and other ingredients. It is diffi- 
cult to see wherein these are superior to the worst 
type of nostrums, and it is unfortunate that they 
should l)e included in a work that has official recog- 
nition. 

The habitual use of these and such preparations 
as Mrs. Winslow's Soothing Syrup, Chamberlain's 



STOMACHICS. 159 

Colic, Cholera and Diarrhea Eeined}^ Kopp's 
Baby's Friend* and others which have been exposed 
in The Jourxal^ can not be too strongly con- 
demned. If an opiate is thought to be necessary, 
it is mncli better to advise the nurse or mother to 
give five drops or more of paregoric, with warnings 
about the disadvantages and the dangers of its in- 
discriminate use. 

CHLOROrORil AXD ETHER. 

Chloroformum. — U. S. P. — As a carminative, 
chloroform probal)ly deserves a much more ex- 
tended use than it now hai^. 

Average dose: 0.3 c.c. (.") minims). This may 
be given either on sugar, in shaved ice, or in ice- 
cold water. 

Spiritus Chloroformi. — U. S. P. — This con- 
tains 6 per cent, of chloroform in alcohol. 

Average dose: 2 c.c. (30 minims). 

Emulsum CiiLOROFOiaii. — U. S. P. — This con- 
tains 4 per cent, of chloroform with a small propor- 
tion of expressed oil of almonds, emulsified with 
tragacanth. 

Average dose: 8 c.c. (2 fiuidrams). 

Aqua Chloroformi. — U. S. P. — This is a sat- 
urated solution containing nhoiit nne-fifth of a 
minim to the teaspoon fiil. 

Average dose: 1(5 c.c. ( I lluidiJiins). 



yP^TliER.— U. S. p.— Kllwr. •'siil|iliiwic 


vWwv" of 


the early pliai'iiiacnpcias. has long \>rrn i 


11 use a.>+ a 


canninativr. 




Average dose: 1 c.c. (15 minims). 





4. See Thi; Jouknal A. M. A., vol. xllv, p. COO. 



KiO PHARMACOPEtA AND PHYSICIAN. 

Spiritus ^theris. — U. S. P. — This contains 
about 33 per cent, of ether. 

Average dose: 4 c.c. (1 flnidram). 

Spiritus ^theris Compositus. — U. S. P. — 
The well-lmown and widely-nsed Hoffman's ano- 
dyne contains, in addition to ether, about 2.5 per 
cent, of ethereal oil. 

Average dose: 4 c.c. (1 fluidram). 

Compound spirit of etlier, in addition to its 
other uses^ has long enjoyed a special reputation in 
hysteria due to gastric disturbances. It is disagree- 
able to the taste, however, and probably possesses 
no advantage over hot whisky and water, or spirit 
of nitrous ether. 

The spirit of chloroform, diluted Avith aromatic 
elixir, or the emulsion of chloroform given alone, 
promptly affords a sense of warmth in the stom- 
ach and will usually give relief in cases of colic 
and pain. 

Chloroform may be prescribed as follows as a 
carminative : 

IJ. Tinct. capsici Siii 12 

Spiritus camphorae 3iii 12 

Chloroformi 3i 4 

Alcohol diluti q. s. ad Siii 100 

M. Sig. : Half a teaspoonful as a dose. 

Alcoholic liquids in general are often useful, but 
their use and their numerous disadvantages can 
not be advantageously discussed in this connection. 

CLOVES AND OTHER AROMATIC SUBSTANCES. 

Cartopiiyllus. — U. S. P. — (Cloves.) — The 
dried flower buds of Eugenia aroniaUca. This rem- 
edy appears to have been known to the early Egyp- 
tians, but was not known to the later Greeks. In 



STOMACHICS. 161 

Europe this drug, probabl}- introduced by the 
Arabians, has been known for centuries. 

Average dose: 0.25 gm. (4 grains). 

OLEUii Caryopiiylli. — U. S. P. — This is a vol- 
atile oil distilled from cloves. 

Average dose: 0.05 c.c. (1 minim). 

The oil of cloves is much more frequently used 
for its anesthetic and caustic effect on exposed 
nerves in carious teeth than as a carminative, but 
it ma}' be used for the latter purpose, in vrhich case 
it is better to add it to spirit of peppermint or 
some other alcoholic carminative preparations be- 
fore diluting vrith water. 

Oil of cinnamon resembles oil of cloves in its 
carminative effect, and the official tincture of cin- 
namon is also useful for the same purpose, but is 
more commonly employed as an adjuvant or flavor 
for other more active carminative agents, and in 
diarrhea. 

Mustard, pepper and nutmeg are not used med- 
icinally as carminatives, but are much employed as 
condiments to serve practically the same purpose. 



CHAPTEE VII. 

" DIGESTAXTS AND DIETETICS. 

The digestive ferments are of only minor im- 
portance in therapeutics, and most often they are 
entirely useless. We know but little of the condi- 
tions demanding their use, and in the great ma- 
jority of cases of indigestion there is no lack of 
these enzymes in the alimentary canal. 

The general subject of dietetics presents a very 
great number of difficulties even to the most skil- 
ful specialist. Frederich Miiller closed a series of 
lectures on "the pathology of digestion" with the 
remark that there were few subjects in medicine 
on which he would be so loath to write a l)ook as 
on that of dietetics. 

In view of this attitude the title of this chapter 
is almost a misnomer, for it is our purpose to call 
attention to some of the abuses which obtain in 
connection with these substances rather than at- 
tempt to give extended information for the use 
of the digestive ferments and the predigested foods. 
The general subject of nutrition, on the other 
hand, is so extensive that it can be touched on only 
very briefly. 

It has been shown repeatedly that where several 
of the digestive ferments are contained in a mix- 
ture one or the other of them is rapidly destroyed. 

The actions which mainly concern us may be 
stated briefly as follows : Dilute hydrochloric acid 
and gastric juice destroy trypsin (pancreatin) and 



DIGESTAXTS AXD DIETETIC!^. 103 

diastase or ptyalin in a few hours, the rate depend- 
ing on the degree of acidity. 

Hydrochloric acid and pepsin act much more 
energetically in destroying these ferments. 

Alkalies alone destroy pepsin, and alkalies plus 
trypsin destroy pepsin very much more rapidly. 
As Sollmann has put it, it is as ahsurd to expect 
the simultaneous action of pepsin and trypsin or 
panereatin as to expect the simultaneous action of 
an acid and an alkali from a mixture of the two. 

Alcohol and numerous other antiseptics slowly 
destroy pepsin so that ready-made preparations are 
of necessity varial)le and very commonly inert. 

The better class of manufacturers claim that 
they make preparations containing pepsin with 
panereatin only in response to a demand. This is 
not wholly true, however, for every text-book 
worthy of note which deals with the subject at all 
states distinctly that pepsin and panereatin are 
incompatil)le, that pepsin acts only in an acid 
medium in which it destroys panereatin, and that 
panereatin destroys pepsin in a neutral or alkaline 
mixture. No writer worthy of attention at present 
pretends that pepsin and panereatin are useful in 
combination, and it is not reasonable to suppose 
that a disreputable firm, making false claims, 
would create so great a demand for a rival's goods 
that the rival would be compelled to put out a mix- 
ture known to be wortliless. 

Tt is difricnlt to understand liow any reasonably 
(•aivriil physician can I'cad tlic c\i(lciicc dii (I)is 
sul)jccl given in 'I'm; .Ioik-n \i. of llie American 
Medical Associal i.m ( Im'Ii. •!. '.» and 1(1. U)07), 
including the article by Sollmann, and continue to 



1C)4 PHARMACOPEIA AND PHYSICIAN. 

prescribe these substances in combination, or even 
singly, except in rare cases. 

The ptyalin of the saliva acts on starchy foods, 
converting them into dextrin and maltose and 
finally into glucose. When the food is thoroughly 
masticated, and thus insalivated, the action of the 
ptyalin may continue in the interior of the food 
masses in the stomach, since the gastric juice acts 
mainly on the external surfaces and, therefore, 
does not come at once into contact with all of the 
contained ptyalin. 

Starchy foods, such as gruel, may be partially 
digested by the addition of diastase (from grain) 
before being taken, but it is wholly useless to take 
diastase in solution, since, as already stated, it 
would be inliibited by the hydrochloric acid and 
destroyed by the pepsin before it could exert any 
important action on the food, because it is not 
then protected by being enclosed in masses of food. 

It is evidently irrational to give pepsin unless 
there is some reason to suppose that there is a de- 
ficiency of that enzyme in the gastric juice, and 
then it should be given in powder or only in fresh- 
ly made solutions, unless the glycerin extract is 
used. 

The practice of giving pepsin, or even a mixture 
of the digestive enzymes in every case of indiges- 
tion, regardless of whether proteids, carbohydrates 
or fats are the disturbing factors, is as irrational 
as would be the practice of trying to cure every 
disease of which fever is a symptom by the use of 
one of the coal tar antipyretics. 

The only conceivable method of giving pan- 



DIGE8TANTS AND DIETETICS. 1G5 

creatin with benefit consists in protecting it from 
solution in the stomach, by coating with keratin 
or salol, or b}' administering it toward the close of 
gastric digestion, in alkaline solution, when it 
would probabh' pass fairly rapidly into the intes- 
tine, but it could exert only a minor influence 
under the latter circumstances. 

Hydrochloric acid is much more frequently 
wanting tlian is pepsin or trypsin and it is some- 
times useful to administer the dilute acid. 

Hydrochloric acid is not a proprietary article, 
however, and there are no financial interests to be 
served by recommending its use. It has been sug- 
gested that much larger doses than those common- 
ly given may be required, but Osier does not advise 
very large amounts. 

It is quite needless to mention the various pro- 
prietary preparations by name which have been 
exploited witli so little credit to the medical pro- 
fession and with such large financial returns to 
their manufacturers, for every intelligent physi- 
cian can supply a liberal number of these names 
for himself, and it can not be too plainly stated 
that all alcoholic preparations of digestive enzymes,, 
whatever the alcohol content may be, are variable 
or inert, and that all mixtures of the various diges- 
tive enzymes are as absurd as mixtures of acids and 
alkalies, wlicrc llie action of the resulting salt is 
not desired, or as it would be to attempt to apply 
heat and cold simultaneously by putting hot water 
and ice in an ice cap. 

It is very much more rational to assist tlie di- 
gestion by dainty appetizing dishes and pleasing 



l(i(i PHARMACOPEIA AND PHYSICIAN. 

surroundings than to administer digestive fer- 
ments.^ 

"N^niiile rennin, occurring in the gastric juice, 
curdles milk, its precise use in digestion is not 
known; in a practical way.it is used to prepare 
curds and whey and is of considerable importance 
in the diet kitchen. 

Trypsin has been suggested as a cure for cancer 
and has been noisily praised as such in the public 
press; it is as yet quite impossible to say whether 
it possesses really curative value or not. It may 
be recalled, however, that it was just as noisily 
proclaimed, some years ago, for the removal of the 
diphtheritic membrane. 

The vegetable pepsin, so called, papayotin, which 
is said to act in acid, alkaline or neutral media, 
has not proved to be of any distinct value, and this 
is only what was to be expected in view of the fact 
that the fault probably seldom lies in the want of 
secretion of the digestive enzymes. 

Hydrolysis or digestion of proteids may also be 
accomplished by means of mineral acids or super- 
heated steam, and it is reported that the resulting 
artificial peptones and albumoses have been of- 
fered as foods. Whatever may be said of the value 
of the predigested foods as a class, it must be ad- 
mitted that the best of them are of little actual 
value, and there is considerable evidence to indi- 
cate that when prepared, by means of mineral acids 

1. That sufficient attention is not paid to this may be 
shown by the experience of one of the authors in one of the 
larger hospitals of New York. While convalescent from 
typhoid fever he was given ice cream and other food with a 
dirty piece of rubber adhesive plaster attached to every spoon 
and article of tableware (except such as he had brought 
from home), and some surprise was expressed that he ate 
almost nothing while in the hospital. 



DIGEHTAyTii AXD DIETETIClS. 167 

or steam, the resulting i^eptones do not act as food. 
Predigested foods should at least be obtained by 
tlie action of the digestive enzymes. 

OFFICIAL PREPARATIOXS. 

Pepsixum. — U. 8. p. — Pepsinum is described 
as a proteolytic ferment or enzyme, derived from 
the glandular la3-er of the fresh stomach of the 
hog. ^Mien assayed according to the process de- 
scribed in the Pharmacopeia, pepsin should be 
capable of digesting no less than 3,000 times its 
own weight of freshly coagulated and disintegrated 
egg albumin. 

Pepsin is soluble in about 50 parts of water, but 
is insoluble in alcohol. It is incompatible with 
alkalies, alcohol, many of the salts of the heavy 
metals and strong mineral acids; even the pres- 
ence of more than 0.5 per cent, of hydrochloric 
acid rapidly destroys its proteolytic activity. 

Average dose: 0.25 gms. (4 grains). 

Paxcreatixum. — U. S. P. — Pancreatin is a 
mixture of enzymes naturally existing in tbe pan- 
creas of warm-blooded animals. The commercial 
article is usually obtained from the pancreas of 
the hog or the ox. It is officially descril)ed as con- 
sisting principally of amylopsin, myopsin, trypsin 
and steapsin, and when assayed Iw the process 
given in tbe Pharmacopeia should be capable of 
converting no less than 25 times its own weight of 
starcli into substances soluble in water. 

i'aiK ivMtin is slowly, but not completely, soluble 
ill water; it is insoluble in alcohol and is incom- 
|)atible with pepsin and mineral acids. 

Average dose: 0.50 gni. (8 grains). 



168 PHARMACOPEIA AND PHYSICIAN. 

ExTRACTUM Malti. — U. S. P. — Extract of 
malt, as now official, has the consistency of thick 
honey and jDossesses amylolytic properties. 

It is frequently used as a vehicle for other sub- 
stances. 

Average dose: 16 c.c. (4 fluidrams). 

NATIONAL FORMULARY PREPARATIONS. 

The abuse and the general uselessness of many 
of the combinations of digestive ferments is well 
illustrated by the preparations that are included 
in the recent, third, edition of the National For- 
mulary. No less than 18 preparations, many of 
them involving well known chemical incompatibil- 
ities, are included. We may enumerate : 

Elixir Pepsini, Bismuthi et Strychnine. — 
N. F. 

Elixir Pepsini et Bismuthi.^N. F. 

Elixir Pepsini et Ferri. — N. F. 

Elixir Cincpion.^, Ferri et Pepsini.^N". F. 

Elixir Cinchon.^, Pepsini et Strychnine. 
— N. F. 

Glyceritum Pepsini. — N. F. 

Liquor Pepsini. — IST. F. 

Liquor Pepsini Aromaticus. — N". F. 

Liquor Pancreaticus. — N. F. 

Pulvis Pepsini Compositus. — N. F. 

Pepsinum Saccharatum. — ]Sr. F. 

Among the more widely used preparations we 
have: 

Elixir Digestivum. — N. F. — Compound di- 
gestive elixir represents a mixture of pepsin, pan- 
creatin and diastase with hydrochloric and lactic 
acids, dissolved in a mixture of glycerin, com- 



DIGESTAXTS AXD DIETETICS. 169 

pound tincture of cardamom and aromatic elixir, 
colored red with tincture of cudbear. 

"While this preparation is generally recognized 
as being inert, so far as digestive properties are 
concerned, it is nevertheless widely used, chiefly as 
a vehicle. It is perhaps needless to add that be- 
cause of the absurdities involved its future use 
should be discouraged, and it is to be hoped that 
future revisions of the ISTational Formulary will 
present in its stead a less objectionable red elixir. 

Average dose: 8 c.c. (2 fluidrams). 

Essentia Pepsixi. — J^. F. — Essence of pepsin 
represents a mixture of pepsin, rennin and a small 
amount of lactic acid in an aromatic vehicle con- 
taining glycerin and wine. In common Avith the 
numerous proprietary preparations of a similar 
nature now on the market, it is essentially a rennin 
preparation and has its chief uses in the making 
of junket, curds and whey, as described below. It 
is also popular as a vehicle for iodids and bromids, 
though tliese, in turn, tend to destroy the con- 
tained pepsin. 

Average dose: 8 c.c. (2 fluidrams). 

PuLvis Pancreaticus Compositus. — jST. F. — 
Peptonizing powder consists of a mixture of two 
parts of pancreatin and eight parts of sodium bi- 
carbonate. It is used in tbe preparation of pep- 
tonized milk and in the making of : 

PULVIS PRO LaCTE HuAfANISATO. — N. F. — Milk 
powder, or humanized unlk powder, represents a 
iiii.xture of 35 parts oL' coinpoiiiiil pancreatic pow- 
der X. F. and 905 parls <.r sii-ar of milk. Tiiis 
pi-("])ai-iiti(»n is designed for use in |ire|i;iiiiig liii- 
nianized milk. 



170 PHARMACOPEIA AND PHYfllCIAN. 

Humanized milk. The directions for this prep- 
aration, as given in the National Formulary, are 
as follows: 

Triturate G.o gms. (100 grains, or about a heap- 
ing teaspoonful) of the humanizing powder with 
60 c.c. (2 fluidounces or about 4 tablespoonfuls) 
of water and transfer the mixture to a clean bottle 
containing 60 c.c. (2 fluidounces or about 4 table- 
spoonfuls) of fresh cows' milk and 15 c.c. (I/2 
fluidounce or about 1 tablespoonful) of fresh sweet 
cream. Mix thoroughl}^ and immerse the bottle in 
water heated to 38° C. (100° F.) for 15 minutes, 
then pour the mixture into a suitable vessel and 
heat it quickly to boiling and then immediately 
allow it to cool to the body temperature. 

Humanized milk should be prepared imme- 
diately before use and the above directions should 
be closely followed. If digestion is too prolonged 
the resulting milk will be bitter and unpalatable. 
For this reason it is necessary to heat the milk to 
boiling at the end of the required time for digest- 
ing the same. 

The milk, and also the cream, should be fresh 
and sweet and quite free from preservatives of all 
kinds. 

Liquor Seriparus. — N". F. — Liquid rennet is 
directed to be prepared from fresh calves' rennet 
and represents approximately about 10 per cent of 
the rennet. 

This preparation may l)e used in the making of 
junket, curds and whey. Where it is to be used 
merely for curdling the milk without separating 
the whey as a distinct layer it should be added to 
the milk previously warmed to a temperature of 



I 



DIGESTAXTS AXD DIETETICS. 171 

about 35° C. (95° F.) but not exceeding 40° C. 
(104 F.). One part of liquid rennet should coag- 
ulate between 200 and 300 parts of cows' milk so 
that the average direction would be to use half a 
teaspoonful to 500 c.c. (1 pint) of milk. 

Junket and whev may also be prepared by using, 
in place of the liquid rennet, the essence of pepsin 
N. F. This preparation contains rennin, and the 
manufacturers of corresponding proprietary prep- 
arations advocate the use of their particular prod- 
ucts because tlie contained pepsin tends to sup- 
ply the proteid matter contained in milk, in a 
partially digested form. Wbile this is of doubt- 
ful advantage, at best, the claim is mis- 
leading unk'ss the preparation is comparatively 
fresh ; the contained rennin has been foUnd to 
retain its activity for a considerable length of 
time and the preparation may be used in place of 
the liquid rennet, in (juantities from four to five 
limes greater. 

Peptonized milk may be prepared by adding 1.5 
gms. (25 grains) of compound pancreatic powder 
N. F. to 125 c.c. (4 fiuidounces) of tepid Avater 
contained in a suitable flask or bottle, and after- 
ward add 500 c.c. (1 pint) of fresh cows' milk, 
previously beated to 38° (100° F.). Maintain the 
lieat at tbis temperature for thirty minutes, then 
transfei- the container to a cool place. 

Peptonized uiilk, prepared in lliis way, should 
not l)e used wbeu it has been kept o\(m- i wenty-four 
liours, or wlicii il bas dcNi'loix'd ;i \i'i-y liiltcr taste. 

The above gcticrnl process for |ic|il(iiii/,('d milk 
may be varied in a niiinln'i- of ways. ;iiiil llic degree 
of digestion may be regulated at will l>y lengthen- 



172 PHARMACOPEIA AND PHYSICIAN. 

ing or shortening the time during which the mix- 
ture is kept warm. It should he remembered, too, 
that digestion takes place even at low temperatures 
and a cold process for peptonizing milk is some- 
times recommended. This consists simply of mix- 
ing the ingredients enumerated in a clean sauce- 
pan or a suitable flask or bottle and placing the 
same on ice without subjecting it to the warming 
process. 

Partially peptonized milk may l)e prepared by 
placing the mixture of peptonizing powder, water 
and milk, in a clean saucepan or suitable flask or 
bottle and gradually heating on a water bath until 
the mixture boils. Then remove and allow to cool, 
or the milk thus prepared may be given while still 
warm. The final boiling destroys the ferment and 
milk thus prepared will not undejgo further pep- 
tonization on standing. 

Peptonized milk may be served with cereals, or 
in the form of jellies flavored with fruit juices or 
other desired flavoring. Where its use must be 
continued for a long period of time it may at times 
be made more acceptable by mixing with equal 
portions of aereated water, or by the addition of an 
alcoholic beverage with or witbout spices, such as 
freshly grated nutmeg. 

The simplest form of partially predigested food 
is toasted bread. Heat converts some of the starch 
into dextrin (brown color) and by making the 
bread more brittle favors insalivation. Burning 
sliould bo avoided, as it not only renders the toaist 
loss pleasant to the taste but the carbonized par- 
ticles are wholly indigestible and may prove irri- 
tating to the stomach and intestines. 



DIGE8TAXTS AXD DIETETICS. 173 

DIETETICS. 

Infant feeding presents a great many problems 
which can only be discussed with profit by special- 
ists, but there are certain simple facts in dietetics 
with which the physician should be more familiar 
tlian he is now and'which require but little thought 
and study. Infant starvation is not at all uncom- 
mon, and many physicians are utterly unable to 
compute the food requirements of the infant (or 
adult) and the food values of various foodstuffs. 
These are exceedingly simple in ordinary cases, 
in contradistinction to the extreme difficulty of the 
subject of infant feeding and dietetics in abnor- 
mal conditions. 

Food values or the energy values of food are 
commonly expressed in calories (from the Latin, 
Calor, heat), a calory being that amount of heat 
wliich is recjuired to raise the temperature of a 
liter of water one degree centigrade. 

An infant under 3 months requires about 100 
calories per day for every kilogram of body weight 
(about 45 calories per pound). The proportionate 
requirement diminishes, and between the ages of 
3 and G montlis the re(iuirement is 90 calories per 
kilogram ( H) caloiics per pound), and between 6 
months and 1 year S(i calories per kilogram (36 
calorics jx-r pound), and tliereafter about 70 
calorics per kilogram (;J0 calories per pound). 

Il i,- iiici-cly necessary to weigh llic cliild and 
limit i|»lv the weight in kilograms nv pounds by 
llic rc(|iiiiriiiciii ill ca1r)rics lo ascertain tlic food 
\;diic needed in ;iny case. 

'I'llis riiiMl \;illle reipiii-einelli is also. Id an ex- 
lent at Icii-^t, dcjjcndcni on ilie siirrace area of the 



174 I'/IAh'.UACOI'ElA AND I'llYSICIAN. 

bod}', hence iimisiially large children will require 
somewhat less food per pound than Mali small 
ones, or, in other words, the food value per pound 
of a large child of 6 months will approximate that 
of a small child of a year. 

Having ascertained the weight and energy re- 
quired in a given case, it is easy to compute the 
calorific value of the food ingested by multiply- 
ing the weight of the carbohydrates and protei*ds 
(starches, sugars and albumin) in grams by 4, 
and the weight of the fats (butter in cream) by 
9 to ascertain approximately the number of calories 
represented. 

One ounce avoirdupois may be taken as 30 
grams roughly (28, more accurately), and an 
ounce of sugar rej^resents about 120 calories, while 
an ounce of butter represents about 250 calories, 
an ordinary egg about 75 calories, a pint of aver- 
age good cows' milk represents about 350 calories, 
mothers' milk somewhat less. The actual value 
should 1)6 determined by examination in any case 
where it seems probable that a breast-fed infant' 
does not get sufficient nourishment. 

Adults require less food per pound of body 
weight than do infants, and in the case of adults 
the requirements vary from 25 calories per kilo- 
gram (12 calories per pound) during rest in bed 
(without fever) to 50 or 60 calories per kilogram 
(22 to 27 calories per pound) during hard labor. 
Increased activity in the adult does not demand a 
proportionate increase in the proteid of the diet, 
if enough carbohydrates and fats are taken, but 
proteid may supply the increased demand. 



DIGE8TAXTS AXD DIETETICS. 175 

During convalescence, when flesh is being added 
to the body, more proteid is required than is 
needed ,ljy a healthy person of the same weight. 

It should be remembered that the food value of 
such vegetables as celery, tomatoes, lettuce and 
cabbage is wholly negligible, so far as calorific val- 
ues are concerned, also that potatoes and rice, as 
they appear on the table, represent probably not 
more than 20 per cent, of starch. Sugar, however, 
is pure carbohydrate except for a wholly negligible 
amount of moisture. 

The commercial liquid predigested foods possess 
no practical food value. It has been sho^vn that 
when predigested proteids are given in amounts 
sufficient to have any practical value their ten- 
dency to cause diarrhea interferes with their use, 
and, furthermore, a person would be kept in a 
state of continued intoxication by the alcohol con- 
tained in much less of the artifi'cial food than 
would be needed for sustaining life, granting that 
life could be sustained by the use of predigested 
foods of this kind. 

For a comparison of the theoretic food values of 
a number of these artificial foods, such as pano- 
pepton, liquid peptonoids, tonic beef and others, 
the reader is advised to read the report of the Coun- 
cil on Pharmacy and Chemistry of the American 
Medical Association {Jour. A. M. A., May 11, 
1007, page 1G12). The figures that are included 
in this r('|)oi-t ai-c I'cally sui-pi'ising, particularly 
rroiii an (■cniKiiiiic iMiiiil ol' \\r\\\ and wci'c it not 



lor the I'act thai Aiiici'ican nici 


lical men 


have paiil 


allogetlior too little atteiilion h 


II a cai'd'Hl 


slii.ly (»r 


the subject of dietetics, the iv| 


Mii't ilscir 


might he 



17G PHARMACOPEIA AND PHYSICIAN. 

held to be evidence of onr absolute carelessness as 
medical men. 

The table that is embodied in tlie report includes 
data obtained from a careful study of eighteen 
samples of medicinal foods made hy ten different 
manufacturers. 

The calories, as proteids and carbohydrates, 
contained in 500 grams varied from 54.7 to 397.5, 
while the approximate cost of this quantity varied 
from $1.00 to $1.54 as compared with milk cost- 
ing approximately 5 cents and containing upward 
of 180 calories of food value in proteids and car- 
bohydrates. 

The additional calories of available food value 
in medicinal foods are embodied in the contained 
alcohol, while in the cows' milk the additional 
food values consist of fat in a readily assimilable 
form. Granting that alcohol has the same food 
value as fat, the cost per day to supply the mini- 
mum number of calories necessary to sustain life 
would vary from $1.56 to $3.39 for the medicinal 
foods as compared to 20 cents for cows' milk. 

If, however, it were practicable to eliminate the 
consideration of the alcohol in medicinal foods and 
of the fat in the milk we would have a cost of 
from $4.33 to $28.97 for the required calories in 
medicinal foods as compared to 39.5 cents for the 
corresponding number of calories, in proteids and 
carbohydrates, to be found in cows' milk. 

In one of these artificial foods the food value of 
the daily dose, exclusive of alcohol, was found to 
be less than 10 calories, or about 1/150 of the total 
amount required by an adult resting in bed. To 
put it in another way, the total daily dose of this 



DIGESTANT8 AND DIETETICS. 177 

medicinal food equalled in food value about one- 
seventh of an egg or an ounce and a half of milk — 
and yet on such frail reeds are we expected to 
lean in a crisis. 

The value of alcohol as a food has been the suli- 
ject of a great deal of discussion. It may be said 
that alcohol may replace carbohydrates or fats, to 
a very small extent, but it does not lessen in the 
slightest degree the minimum amount of proteid 
metabolized, which must be supplied in the food 
or drawn from the tissues. In other words, if a 
patient is able to take a bare sufficiency of carbo- 
hydrates and fats the addition of alcohol does not 
diminish the amount of proteid which must bo 
taken to prevent loss of weight. 

According to the researches of Chittenden, the 
minimum proteid requirement for adults is mucli 
less tlian was formerly supposed. He found that 
40 grams (li/j ounces) of ordinary beef or six 
eggs (roughly), with carbohydrates sufficed to 
keep himself, weighing GO kilograms (130 pounds) 
in nitrogen equilibrium. 

"\Miilc the minimum re(iuirement is a matter of 
importance when one wishes to supply the actual 
needs of the body, it is not often that the diet of 
healthy adults does not contain an excess of i)ro- 
teid except among tbe very poor. 

Professor Chittenden thinks proteids greatly in 
excess of the minimum ref[uircmcnts arc injurious, 
Init this view is not generally accepted, and some 
standard dietaries give 150 grams (5 ounces) or 
more of proteid corresponding to about ()')0 grams 
(1/4 pounds) of beef a.s the daily amount for 



178 PHARMACOPEIA AND PHYSICIAN. 

a man weighing 70 kilograms (150 pounds) doing 
liard work. 

Standard dietaries show considerable variation, 
^vhether it he for prison fare or the ration of the 
soldier or hospital diet. 

Two of these are given in order to afford an ap- 
proximate idea of the kind and quantity of foods 
required under different conditions. The amounts 
in the first table are for a man weighing 70 kilo- 
grams (150 pounds) with work varying from light 
work to hard labor. 

Proteid 100 to 150 grains ( 3 to 5 ounces) 

Fat 46 to 100 grams ( ly, to 3 ounces) 

Carbohydrates 375 to 565 grams (13 to 20 ounces) 

The total calories in this list vary from 2,450 to 4,150. 

The following table represents approximately the 
average diets of several hospitals in Germany : 

Proteid 100 grams (3 ounces) 

Fat 50 grams (1^2 ounces) 

Carbohydrates 150 to 400 grams (5 to 13 ounces) 

Here the calorific values varv from about 1,400 to 
2,300. 

It should be remembered that ordinary beef or 
other meat may contain more fat than proteid, but 
the leanest meat obtainable may be considered as 
about one-third proteid. An egg contains approxi- 
mately 6 grams of proteid, while cereals contain 
little or none. 



CHAPTEE YIII. 

ASTEIXGEJsTTS. 

Astringents are substances which produce a con- 
striction of all the solid tissues with' which they are 
brought into intimate contact. Substances of this 
chiss have a peculiar action on mucous membranes, 
causing wrinkling of their surfaces and diminution 
of secretion; they precipitate not only proteids and 
gelatin, but also alkaloids and many glucosids. 

The action of astringents, irritants and caustics 
is largely a matter of degree, the caustics acting as 
astringents when sufficiently diluted, while all as- 
tringents produce at least a transient and slight 
irritation, and when applied in concentrated form 
to mucous membranes many of those classed as 
mere astringents are capable of causing consider- 
al)le irritation, which in the stomach may give rise 
to vomiting,, and in the intestine to diarrhea. Some 
astringents are essentially mild in tluir action, 
wbile others, being nearly insohil)lr. cnii not be 
brought into intimate contact witli the tissues in 
concentrated ff)rni ; these can not produce more 
than a \(it mild and fleeting irritation, or stimu- 
hilioii. wliicli is followed by lessened permeability 
i)\' the cjiiiillai-y walls ami diminished congestion. 

Uy tlicii- ii-i-iiaiit aclioii. drii-s of this partic- 
ular class nuiy inci'casc a scscrc aculc iullamma- 
tii)M wiiiioul being able bi pi'ddiicc their lypical as- 
ti'ingent cflVct. Ik'Mcc they arc ikiI nearly so useful 
in such conditions as in chronic inllamiiuitions. 



180 PHARMACOPEIA AND PHYSICIAN. 

The vegetable astringents owe their action mainly 
to the presence of tannins, substances belonging to 
an ill-defined group, possessing an astringent ac- 
tion as their best defined property. Other or- 
ganic acids play only a minor role as astringents. 
The tannins give blue-black or greenish-black re- 
actions with ferric salts; they precipitate proteids 
(leather being the product formed with connective 
tissue), alkaloids, metals and some other sub- 
stances; they yield pyrocatechin or pyrogallol on 
destructive distillation. Their therapeutic actions 
are independent of their chemical peculiarities, and 
they are severally indicated rather with reference 
to the presence or absence of extractive matter. 

The combination of tannin with peptone is in- 
soluble in the gastric juice, and this and the insolu- 
ble albumin tannates are decomposed in the alka- 
line juice of the intestine, the tannin forming alka- 
line tannates which possess little or no astringent 
action. If the free tannins reach the intestine after 
the administration of extracts of the crude drugs,, 
they act on the mucous membrane, lessening intes- 
tinal secretion; this greatly modifies the bacterial 
development, and, therefore, the general intestinal 
conditions. Some of the metallic albuminates are 
soluble in an excess of proteid, and when in such a 
case the liberated acid is corrosive there is a pen- 
etrating corrosive action such as that of zinc or 
mercuric chlorid. With an insoluble precipitate, 
such as lead albuminate^ which forms an imper- 
vious coating, and a mildly astringent acid, like 
acetic, there is a typical astringent and non-irri- 
tant effect. 

The same astringent substance may be used in a 



ASTRIXGENTS. 181 

variety of conditions^ and a number of different 
astringents are applicable to a given condition. A 
better acquaintance with the different tannins may 
lead to the selection of certain ones for particular 
cases, but at the present time we are guided more 
by the physical condition in which a given one is 
available; thus the official tannic acid is readily 
dissolved in the stomach, where it combines with 
the proteid of the content, or with the mucous 
membrane, whereas the tannin of gambir (gambir 
replaces the catechu of the Pharmacopeia of 1890) 
is protected by the presence of gum and extrac- 
tives, and so passes into the intestine, there to exert 
its astringent effect. We can not attempt anything 
like a complete enumeration of the various uses of 
the astringents, but must content ourselves with 
summarizing briefly the principal indications of 
astringents and some of the chief characteristics 
of the more common remedies of this type. 

USES OF ASTRINGENTS. 

Astringents are used internally in the treatment 
of diarrhea and dysentery, in congestion of the mu- 
cous membrane of the stomach and intestines, and 
for hemorrhage in the alimentary canal and other 
directly accessible regions. The use of astringents 
— either organic or inorganic — for their effects on 
parts which can only be reached by way of the 
blood vessels is wholly irrational, and when benefit 
follows it is not due to the astringent action, since 
by their very nature astringents can not exist free 
in the blood in sufficient concentration to exert an 
astringent action. Traces of tannin are not as- 
tringent any more than they are irritant, and as- 



182 PHARMACOPEIA AND PHYSICIAN. 

tringents act only when lirought into intimate con- 
tact with the tissue in sufficient concentration. 

The metals are poisonous when absorhed, and, 
as a rule, vegetable astringents are to be preferred 
for internal administration, particularly when they 
must be used for a considerable period. Pure tan- 
nin, or tannic acid^ as it is designated in the 
Pharmacopeia, may be used locally whenever a 
purely astringent action is indicated ; for example, 
when secretion is excessive, and when it is desired 
to harden the skin in order to prevent excessive 
sweating. 

The treatment of accessible, inflamed mucous 
membranes with antiseptic solutions, and more 
particularly with solutions of hydrogen dioxid, has 
greatly lessened the use of astringents, and the 
cleansing of an infected surface should be a rou- 
tine procedure even when an astringent is to be 
applied subsequently. Dry tannin insufflated 
against an elongated palate often affords instan- 
taneous relief. 

Tannin in the pure state is rarely used inter- 
nally because of its irritant action on the stomach, 
one of the preparations of astringent drugs being 
preferred in such cases. The dry powder acts as a 
styptic when applied to bleeding surfaces, but it 
must be borne in mind that tannic acid and all 
other astringents when given l)y mouth exert their 
astringent action only on the alimentary canal. 

The various proprietary remedies, composed of 
tannin and albumin, gelatin or albuminoids, have 
not been shown to possess any decided therapeutic 
advantages over the official astringents, and sev- 
eral of the proprietary compounds, owing to their 



ASTEINGEyrS. 183 

variable composition, must necessarily be uncertain 
in their actions. 

Tannic acid in simple solution combines with 
the albuminous contents of the .stomach, and with 
the mucous membrane itself if the stomach be 
empty and the tannin in concentrated solution; 
it may tben give rise to vomiting and even to 
diarrhea. Tbis irritant action of the astringents 
leads to the use of several of them — alum, and zinc 
and copper sulphate — as emetics. 

Tannin, being a precipitant of alkaloids, is use- 
ful as an antidote to those poisons when they are 
in the stomach — not when they have been given 
bypodermically, except possibly in the case of 
morphin, which is excreted into the stomach. The 
tannates tbus formed are slowly broken up, and 
the stomach must Ije evacuated by emetics, or, 
jjreferably, by tbe .stomach pump, as promptly as 
possible, tannin being added to the water which is 
used to wash tbe stomach after evacuation. Tea 
and coffee contain tannin, and, since they are al- 
most universally available in emergencies, their 
use is very common. Toi'ald Sollmann^ deter- 
mined the cnicicncy of in fusions of tea and coffee 
as pi'ccipiliuils fdi' \ai-i()us alkaloids and metals, 
and fouiid the infusion of lea innrli tbe more ac- 
tive, Ijut licit bor of ilicni voiT ivlialilc foi- tlie com- 
nionlv u.^od alkaloids, wliilo llir only uietals for 
\\lii(li I'M (infusion) would \>r useful are mercury, 
lead and silver. As a siuL;lc dose of lead never 
gives rise to acute sym|)lonis, and as poisoning 
with silver salts is cxti-cnidy larc we must con- 
clude Hull [)oisoning wilb inei-cui'ic salts is practi- 



18-4 PHARMACOPEIA AND PHYSICIAN. 

cally the only instance likely to be encountered in 
which tea would prove to be an effective precipi- 
tant. The use of tea and coffee as stimulants in 
poisoning depends mainly on the caffoin, and, of 
course, these remarks as to their limitations do not 
apply to the stimulant use of them. 

VEGETABLE ASTRINGENTS. 

AciDUM Tannicum. — U. S. p. — This is a light 
yellowish amorphous powder of a characteristic 
odor and a strongly astringent taste; it is very 
soluble in M'ater. alcohol or glycerin. 

Average close: 0.5 gm. (8 grains). 

Glyceritum Acidi Tannic:. — U. S. P. — A 20 
per cent, solution of tannic acid in glycerin. 

Average dose: 2 c.c. (30 minims). 

Teochisci Acidi Tannici. — IT. S. P. — Each 
troche contains 0.06 gm. (1 grain) of tannic acid 
with sugar and tragacanth, flavored with orange- 
flower water. ' 

Gambie. — U. S. P. — Gambir was introduced 
into the present Pharmacopeia to replace catechu 
'of the earlier editions. It is an extract prepared 
from the leaves and twigs of Ourouparia gambir 
and occurs in irregular masses, varying in color 
from reddish browu to a pale brownish gray. It is 
inodorous, but has a slightly bitter, very astringent 
taste, with a sweetish after-taste. 

Average dose: 1 gm. (15 grains). 

TiNCTUEA Gambir Composita. — U. S. P. — This 
represents 5 per cent, of gambir and 2.5 per cent, 
of Saigon cinnamon in diluted alcohol. 

Average dose: 4 c.c. (1 fluidram). 



ASTRINGENTS. 185 

Trochisci Gambir. — U. S. P. — Each troche 
contains 0.06 gm. (1 grain) of gambir with sugar 
and tragacanth, flavored with orange-flower water. 

Kixo. — U. S. P. — The inspissated juice of 
Pterocarpus marsupium was introduced into medi- 
cine by Dr. John Fothergill about 1757. 

Average dose: 0.5 gm. (8 grains). 

TiNCTURA Kixo. — U. S. P. — The strength of 
this preparation has been reduced to 5 per cent, to 
obviate its tendenc}' to gelatinize. 

Average dose: 4 c.c. (1 fluidram). 

The vegetable drugs that contain tannin are so 
numerous, and their general therapeutic actions 
are so similar, that we shall merely enumerate the 
following well-known vegetalde astringents and 
official preparations : 

RUBUS (blackberry-root l^ark).- — Fhiidextract 
and Syrup. 

Red Rose. — Fhiidextract and Syrup. 

Geranium. — Fhiidextract. 

Heaiatoxylon. — Extract. 

Rhus Glabr.v. — Fhiidextract. 

A combination of chalk which has attained very 
great popularity in tbo treatment of diarrhea is 
tbe 

MiSTURA Vm^TjR. — U. S. P. — Chalk ]\rixtiire 
lias the following composition : 

Prepared chalk, G gm. (90 grains) ; powd. aca- 
cia, 4 gm. (()0 grains) ; powd. sugar, 10 gm. (150 
grains); cinnamon water. K) c.c. (10 fliiidrams), 
with water cnmigli i.. make 1 00 ,■.<•. (;) fluid- 
ounces). 

The average dose is 4 teaspoonfuls (15 c.c). 



186 PHARMACOPEIA AND PHYSICIAN. 

Chalk mixture is so well known that it is men- 
tioned merely as a reminder of one of our best and 
simplest remedies for diarrhea. It is peculiarly 
adapted for combating the diarrliea of children. 
Severe c^ses may require the addition of a few 
drops of the deodorized tincture of opium to each 
adult dose or a suitable amount of paregoric (the 
camphorated tincture of opium) for children. 

Troches of tannic acid are used almost exclusive- 
ly in affections of the mouth and throat. 

Gambir (catechu), kino, krameria and many 
other vegetable drugs contain large amounts of 
their peculiar tannins, together with mucilaginous 
and other extractive matter which tends to pre- 
vent the tannin from forming compounds in the 
stomach and thus preclude its action on the mu- 
cous membrane before it comes into the intestine, 
hence the preparations of these substances are more 
useful in the treatment of diarrhea than are pure 
tannin and its preparations. 

Troches of gambir are well adapted for use in 
sore throat, after the throat has been sprayed with 
a solution of hydrogen dioxid, instead of the as- 
tringent gargles which were formerly so much in 
vogue. 

Kino, like Gambir, may be given as a powder, 
prefejably combined with opium and aromatics, 
as in the "Compound Kino Powder," N. F., which 
contains : Kino, 75 ; cinnamon, 20 ; powdered 
opium, 5 parts. 

The following prescription, though somewhat 
complex, is a slightly modified form of one used in 
certain hospitals with satisfactory results; al- 
though the chalk is alkaline, it does not appreci- 



ASTRINGENTS. 187 

ably lessen the astringency of the mixture, as do 
the carbonates of the alkalies which exist in the 
intestine. The compound tincture of gambir, or 
the tincture of krameria, may be used instead of 
the tincture of kino : 

ft. Cretae prseparatae 3i 4 

Tincturse kino 3iv 15 

Tincturte opii m. v 3 

Spiritus chloroformi m. Ixxv 5 

AqUcT menthpe piperitae 3x 40 

Sj'iupi aurantii q. s §iii 100 

For children of from 3 to 10 years of age, from 
one-half to one teaspoonful of this mixture may be 
given every two or three hours ; for adults the dose 
is one tablespoonful. 

Gallic acid is sometimes recommended as an 
astringent, but it possesses no such action except 
that of any very weak acid, and it is absolutely 
useless for hemorrhage in the lungs, kidneys and 
other regions reached only by the circulation. 

Thougii opium does not contain tannin, it would 
be a distinct omission if we failed to mention some 
of its indications in this place, since this work is 
intended primarily to call attention to the pos- 
sible therapeutic uses of the official substances, and 
since the arrangement into groups, such as as- 
tringents, is merely for convenience. Small doses 
of any of the opium preparations afEord one of the 
surest means of iclid' in diarrhea. They are 
commonly coiiihiufil with astringents, inorganic, 
as well as organic, with excellent results, despite 
the chemical incoiii]iiitiliiliiy existing between the 
alkaloids and tlie varidii- taiiiiiiis or' iiielallic sails. 
The jireiiai-atioiis (if npiiini will lie nienlioiKMl in 
the later chapters, and we now niei'i-ly wish lo call 
attention to methods of condiinin": these a"-onts. 



188 PHARMACOPEIA AND PHYHICIAN. 

I^. TineturtE gambir conipositiP gi 30| 

Tincturse opii deodorati m. x 5 

Bismiithi subnitratis 3iiss 10 

Aquae camphorae q. s ^iii 100 

Sig. : One teaspoonful hourly for three or four hours, 
then every two or tln-ee hours. 

Any one of the insoluble bismuth salts may be 
used, and tincture of kino or krameria substituted 
for the compound tincture of gambir. Similarly, 
an appropriate amount of the camphorated tinc- 
ture of opium may be substituted for the deodor- 
ized tincture. . When it is desired to give the same 
active ingredients in the form of a dry powder the 
following may be used : 

I^. Opii pulveris gr. v 13 

Bismuthi subnitratis gr. cl 10 1 

M. Et div. in chart, x. 

Sig. : One powder to be given every two, three or fovu' 
hours, according to the needs of the patient. 

Here, again, the combination may be varied 
almost endlessly by using one of the other in- 
soluble bismuth salts, the deodorized opium, or 
by adding a small proportion of one of the veget- 
able astringents like kino or gambir. 

The pill of lead and opium is well adapted for 
securing a very slowly soluble form for adminis- 
tering these drugs. The pill is useful in diarrhea, 
but must not be long continued, lest it give rise to 
lead poisoning. 

IJ. Plumbi acetatis gr. xx 113 

Opii pulveris gr. x J6 

M. Fac pilulas No. x. 

Sig.: One pill to be given three or four times a day. 

Inflammation of the stomach and intestine and 
gastric ulcer may be treated by an insoluble as- 
tringent powder which not only relieves conges- 
tion by its astringent property, but also forms an 



ASTRINGENTS. 189 

insoluble protective covering, preventing the con- 
tact of irritating particles of food and the gastric 
and intestinal secretions, besides lessening the 
amount of these secretions. 

METALLIC ASTRIXGEXTS. 

The insoluble salts of bismuth are admirably 
adapted for the protection of the intestinal mu- 
cosa from irritants of various kinds. While as 
much as thirt}-. times the average single dose of 
bismuth salts has been given in the course of a day, 
by the mouth, without any distinct evidence of un- 
toward results, absorption and poisoning have fol- 
lowed the external use of bismuth salts as a dusting 
powder when used over a large surface. 

Owing to the extremely poisonous nature of bis- 
muth when absorbed, the solu])le salts seem to us 
to be entirely superfluous, particularly as their 
solubility, until precipitation occurs, precludes the 
very object for M'hich bismuth compounds are 
chiefly used — that is, for the mechanical coating of 
the surface with a protective layer of insoluble 
powder. It must be admitted, of course, that even 
the soluble salts of bismuth are astringent, but we 
have many safer astringents which ai-c harmless 
that might well be used in their stead. 

The activity of the noslniin-iiinkcrs has resulted 
in ])lacing on the market a iiiinilici' n\' picparations 
that are intended to coml)ine the aiiliscptic proper- 
tics of the benzene derivatives willi the astringent 
|ir()|icrtics of hismiith. hut iiiilil \vc kimw more of 
the possihilitics ;iii(l the I i in i1 ;ili..n> nF int. ■Mini an- 
tiseptics it is prel'crahh' to use the siniph' astrin- 
gents and to use our aiitiscplics separately. 



inn PHARMACOPEIA AXD PHY8ICIAN. 

BiSMUTHi SuBNiTEAS.- — U. S. P. — All insolu- 
ble white powder, without odor or taste. 

BisjruTTii SuBCAEBOxAs. — U. S. P. — Closel}" re- 
sembles the subnitrate. 

Average dose (of cither salt) : 0.5 gm. (8 
grains). 

BiSMUTHI SUBSALICYLAS. — U. S. P. — This 
preparation closely resembles the subnitrate in 
physical properties and is intended to combine the 
antiseptic properties of the salicylic acid with the 
astringency of bismuth salts. 

Average dose: 0.35 gm. (4 grains). 

BiSMUTHI SuBGALLAS. — U. S. P. — This prepa- 
ration was at one time widely advertised and is 
even now occasionally prescribed by its proprietary 
name, dermatol. It occurs as a bright yellowish, 
insoluble, odorless and tasteless powder, which is 
mostly used externally as a substitute for iodo- 
form. 

It possesses the advantage over the subnitrate of 



2. A typical prescription for gastri<' iiu-itation. or ulcer, 
is as follows : 

R. Bismuthi subnitratis grs. cl 101 

Mucilaginis acacisB 3xii 50 

Aquae cinnamomi q. s. ad Siii lOOf 

M. Sig. : Shake well and take one or two teaspoonfuls 
three or four times a day. 

In cases in which marked irritability persists, the addi- 
tion of 0.01 gm. (1/6 grain) of cocain hydrochlorid to each 
dose, as a local anesthetic, may be advantageous, but we do 
not advise it as a routine procedure. For diarrhea one or 
two drops of the deodorized tincture of opium may be in- 
cluded for each dose, or, if preferred, tincture of opium. For 
this purpose, it is usually preferable to give one dose every 
hour for three or four doses, then every two to four hours as 
needed. Bismuth subcarbonate may be used instead of the 
subnitrate and tincture of kino, tincture of krameria or the 
compound tincture of gambir (catechu) may be added in 
the treatment of diarrhea. 



ASTRINGENTS. 191 

not being very liable to absorption when used as a 
dusting powder. 

Average dose: 0.25 gin. (4 grains). 

PLinrBi AcETAS. — IT. S. P. — Acetate of lead, 
or sugar of lead, is said to have been known to 
Geber. It was described by Eaymund Lully in the 
thirteenth centur}', but was not used in medicine 
until introduced by Goulard a little more than a 
century ago. It occurs in crystals or as a heavy 
white powder, having an acetous odor and a sweet- 
ish, astringent, afterward metallic taste. 

Average dose: 0.05 gm. (1 grain). 

Liquor Plumbi Subacetatis. — U. S. P. — An 
aqueous solution containing not less than 25 per 
cent, of lead subacetate. 

Liquor Plumbi Subacetatis Dilutus. — U. S. 
P. — This contains about 1 per cent, of lead sub- 
acetate and is made by mixing 4 parts of the solu- 
tion of lead subacetate with 96 parts of distilled 
water. 

The official salts of zinc that are of interest as 
astringents are: 

Zixn SuT.iMrAS. — T". S. P. — Colorless crystals, 
wilboiit ddni'. li;i\iiig an asti'ingont nictallie taste. 
Zinc sulpbate is soluiile in loss than 1 ]iart of 
water, but is insoluble in nlcnlml. 

Average dose: Emetic, 1 gm. (15 grains). 

ZlNCI PllENOLSULPTTONATE. — IT. S. P. — The 
zinc <iilpliocnrliolai(' of pi'cxions editions' ol' the 
IM)ai-inac<.|)i'i:i has hccn ivlmvil In uiicln- antisep- 
tics. 

Average dose: 0.12 gni. ("i gi'ains). 



192 PBARMACOPEIA AND PHYSICIAN. 

ZiNCi AcETAS. — U. S. P. — This is a widely used 
and deservedly popular astringent. 

-Average dose: 0.12 gni. (2 grains). 

ZiNCi OxiDUM. — 11. S. P. — A white or yellow- 
ish-white powder, insolnhle in either water or alco- 
hol, it is largely used as a local application in dust- 
ing powders and in ointments, but is seldom given 
internally. 

Average dose: 0.25 gm. (4 grains). 

COPPER AND IRON SALTS. 

CuPRi Sulphas. — U. S. P. — Blue stone or blue 
vitriol was known to the Greeks as chalkanthos. 
Dioscorides described it as being a valuable astrin- 
gent and, in large doses, emetic. It occurs as deep 
blue crystals that are devoid of odor, but have 
a nauseouS; metallic taste. It is soluble in about 3 
parts of water. 

Average dose as an astringent". 0.01 gm. (10 
mg. or 1/5 grain) ; as an emetic. 0.25 gm. (4 
grains) . 

Of the numerous preparations of iron that have 
astringent properties we will mention but one, the 
chlorid, as representative of the whole class. This 
is official in several forms : 

Ferri Chloridum. — U. S. P. — This occurs in 
orange-yellow crystalline pieces, nearly odorless, 
but having a strongly styptic taste. 

Average dose: 0.05 gm. (1 grain). 

Liquor Ferri Ciiloridi. — U. S. P. — An 
aqueous solution of ferric chlorid, containing about 
29 per cent, of the anhydrous salt. 

Average dose: 0.1 c.c. (liA minims). 



ASTRIXGEXT.S. 193 

This preparation is but little used, except for 
preparing 

TixcTURA Ferri Chloridi. — U. S. P. — This is 
made by adding 35 parts of solution of ferric 
chlorid to enough alcohol to make 100 c.c. 
The official tincture is directed to be prepared at 
least three months before being used. 

Average dose: 0.5 c.c. (8 minims). 

This preparation is injurious to the teeth; there- 
fore, it should be directed to be taken througli a 
tube and the mouth rinsed with water or a ver}^ 
mild solution of an alkali, like lime water. 

The only official preparation of silver that is of 
direct interest in connection with astringents is 

Argenti Nitras. — U. S. P. — This salt is sup- 
posed to have been known to Geber, but was intro- 
duced into medicine by Angelus Sala during the 
seventeenth century. It is very soluble in water and 
occurs as colorless, transparent, tabular crystals, 
that darken on exposure to light in the presence of 
organic matter. It is odorless, but has a bitter, 
caustic and strongly metallic taste. 

Average dose: 0.01 gm. (10 mg.. or 1/5 grain). 

Alumen. — U. S. P. — Alum should contain not 
less than 99.5 per cent, of pure aluminum and po- 
tassium sulphate. It occurs as colorless crystals or 
as a wliite powder; it is odorless, but has a sweet- 
isJi and strongly astringent taste. Alum is soluble 
in 9 parts of water, but is insoluble in alcohol. 

Average dose: 0.5 gm. (8 grains). 

.Vlu.mkn- Exsiccatum. — U. S. P. — Popularly 
known as dried "alum, must contain not less than 
!»!> per cent, of anhydrous aluminum and potas- 
sium sulphate. 



194 PHARMACOPEIA AND PHYSICIAN. 

OFFICIAL LEAD SALTS. 

Lead is of interest cliiefly because of the crironic 
lead poisoning so often encountered. 

The principal internal use of lead is in the form 
of the pill of the acetate, usually combined with 
opium, in the treatment of diarrhea. It has also 
been recommended for dysentery, but is not nearly 
so useful in that disease. This preparation should 
not be given for any considerable length of time, 
lest it give rise to chronic lead poisoning. The 
solution of lead subacetate is unfit for internal 
administration, but is of value in painful swell- 
ings and local inflammations and burns. The 
well-known mixture of laudanum and lead water 
has long been popular as an external application, 
but any mucilaginous liquid could probably be 
used in place of the tincture of opium without 
detriment, since the astringency of the lead is the 
main factor, the local application of the opium 
alkaloids being entirely superfluous because they 
are not absorbed from the unbroken skin. The local 
use of lead watei- itself is so thorouglily well estal)- 
lished that it scarcely requires further comment.' 

THE LOCAL TREATMENT OF MUCOUS MEMBRANES. 

The local treatment of inflammation of the mu- 
cous membranes in the mouth, nose, throat, vagina 
and urethra, after thorough cleansing, preferably 

3. The foUowing mixture wiU probably answer the pur- 
poses for which laudanum and lead water are commonly used : 

R.. Liq. plumbi subacet min. Ixxv 5| 

Mucil. acac min. xlv 31 

AquiB q. s. ad f. Siii 100 1 

The solution of lead subacetate is diluted with oo c.c. (16 
fluidrams) of water and the mucilage with 37 c.c. (10 
fluidrams) : the two are then mixed. Fifteen c.c. (4 
fluidrams) of the water may be replaced by alcohol, but 
the amount of alcohol present in the mixture of laudanum 
and lead water is too small to be of any benefit. 



ASTRINGENTS. 195 

■with a solution of hydrogen dioxid, may require 
mild astringents of either organic or inorganic sub- 
stances, though, as previously stated, the use of the 
solution of hydrogen dioxid has greatly lessened 
this necessity. Alum has long enjoyed a particular 
reputation in the treatment of stomatitis, and has 
also been used as a gargle, but it is injurious to the 
feeth. and the necessary solution, made of 1 part of 
ahim in 20 parts of water, is preferably applied 
directly to the affected parts by means of a camel's- 
liair pencil or a swab made of absorbent cotton. 
After gargling, the moutli should be rinsed with 
water. Alum is not given internally so often as it 
was formerly; it is irritating and possesses no ad- 
vantages over otlier astringents. Because of this 
irritaut action it is emetic, and, while not very 
dependable, may serve in an emergency if no surer 
emetic is at hand. Small ulcerations of the throat, 
after having been cleansed witli an antiseptic so-' 
lution. may be touched with a mixture of 1 part 
of fci-ric subsulphate and 2 parts of gh^cerin. using 
a caiiicrs-liair pencil or a cotton swab. 

A \ci'y lai'^v miinbcr nf a-tringent gargles are in 
coiiiiiion iiM'. lull tin- following is a good represen- 
tative of the class : 

R. TinetuviP foni dihjridi ni. el 10 

Potassii c'hloratis Siii 12 

Aquae q. s f^vi 200 

Tliosc who olijccl to the use of ferric chlorid 

iiiav liiid tlir r.,|lo\viii,- |)rcrcMil)lc: 

li. Clvcriili aci<li himiici f5v 20| 

.\(|ini' (|. s fSJvi 200| 

JJi'icd aliiiii is iisi'il foi- the same ])urpnscs as 
alum, and, in addilion. i,- .-onicwliai canslic when 
dusted, as a dry puwdi'i'. on cxubrrant growths. 



190 PHARMACOPEIA AND PHYSICIAN. 

THE USE or ZINC SALTS. 

Zinc sulphate and zinc phenol sulphonate may be 
considered together; they have a variety of appli- 
cations, and it is only necessary to suggest the 
strength of the solutions that are to be used for 
various purposes. 

For the eye they are generally used in the 
strength of from one-fourth to one-half of 1 per 
cent, in a solution of boric acid, to which camphor 
water may be added. 

For the urethra strong solutions should not be 
used, one-half of 1 per cent, in Avater being suffi- 
cient. The popular combination of zinc sulphate 
and lead acetate, resulting in the insoluble lead 
sulphate and the very astringent zinc acetate, may 
possess some advantages over the more simple so- 
lution, but they are not very apparent. 

Vaginal douches may be somewhat stronger and 
are frequently prescribed of from 1 to 2 per cent, 
strength. 

As noted before, all the astringents may act as 
emetics if they are sufficiently irritant to the mu- 
cous membrane of the stomach and are not caustic. 
Zinc sulphate, however, deserves the preference 
among the astringents used as emetics. For this 
purpose it is usually given in doses of 1 or 2 gm. 
(15 to 30 grains) dissolved in a teacupful of warm 
water. 

USE OF SILVER NITRATE. 

Silver nitrate in the form of sticks, lunar caus- 
tic, is mainly used as a caustic- for touching warts 
of various kinds and for non-granulating wounds. 
A solution of silver nitrate is sometimes used as an 
application to the conjunctiva, followed at once 



ASTRINGE^'TS. 197 

by a solution of <oJium chloric!, whereb}' a mo- 
mentary action of the silver nitrate is obtained, the 
nitrate being instantly converted into the chlorid 
when the solution of sodium chlorid is applied. 

Silver in combination with different proteids 
has been introduced under a variety of trade- 
marked or proprietary names and recommended 
as a non-irritant antiseptic, mainly for the treat- 
ment of gonorrhea. Crede some years ago intro- 
duced a soluljle form of metallic silver, for which 
certain manufacturers make the fabulous claim 
that it is an efficient disinfectant of blood and tis- 
sue. So long as septic diseases resist all treatment, 
it seems strange that reputable manufacturers will 
make such obvious misstatements. 

The internal use of silver nitrate as an astrin- 
gent is necessarily empirical, as the compound 
that is formed when silver nitrate is brought inio 
contact with organic matter must be complex and 
problematic. A favorite pill of the late Dr. 
William Pepper for chronic gastritis was the fol- 
lowing. It is submitted without comment : 



IJ. Argenti ni 
Extract! h; 
Mannae, a a 


tratis 
yoscyaini 


o-r 


'. 1/3 


02 


Fiat pilula No. 


]'. 


b' 




Such a pill w 


as directed to be given three or four 


times a (hiy, an 


(1 Ihe composition was occasionally 


varied by substi 


itnling 1 


)o\v(lcr(.'d ()]i 


iuni for 


the ex- 


tract of hyoseyi 


imus. 










VASOCONSTRICTORS. 






In adililion 


to ihe ! 


t stringent d 


rugs dc 


pending 


on iaiinin oi' 1 


Iir IIH'ia 


llic >^alis. (• 


ci'lain a 


Ikaloids 


])()S.-;('.ss a Jiiarki 


cdlv asl 


riiigent, or, 


more |i 


iropcrly. 



198 PHARMACOPEIA AND PHYSICTAN. 

vasoconstrictor, effect when applied to mucous 
membranes. Of these, the most useful are hydras- 
tinin, a derivative of hydrastin, from which it is 
obtained by oxidation, and the alkaloid of the 
suprarenal gland. Here we are compelled to admit 
that this latter alkaloid, which is now being mar- 
keted at the modest price of some $800 per ounce, 
despite Abel's simple and inexpensive method of 
preparation, is superior to the official desiccated 
suprarenal gland. The application of a 1 to 1,000 
solution of hydrastinin or a 1 to 5,000 solution of 
the suprarenal alkaloid, in 0.9 per cent, solution 
of sodium chlorid, to an inflamed conjunctiva or 
inflamed nasal mucous membrane often affords 
prompt relief. In view of the very great difference 
in cost without a corresponding difference in ef- 
fect, the physician can well afford to use hydras- 
tinin in preference to the more expensive alkaloid 
in such conditions. 

The desiccated suprarenal gland may be mace- 
rated in water and the fluid filtered and used, but 
any of the preparations of the alkaloid which 
appear under a variety of trade names will usually 
be preferred. Slight hemorrhages are also stopped 
by either of these means. 

When the flow of blood is copious and hot water 
is ineffective, styptics are useful; they are not 
alone astringent, but also cause a sudden coagula- 
tion of the blood, and this plugs up the oriflce. 
Large clots must be removed, as they prevent the 
immediate contact of the astringent or styptic and 
may conceal a hemorrhage occurring in cavities — 
the uterus, for instance — in which case the clot 
may fill the upper part of the vagina. 



ASTRIXGEXTS. 199 

It is necessary to bear in mind the dijfference be- 
tween the action of vasoconstrictors, like the alka- 
loid of the suprarenal gland, and the action of 
styptics, like tannin or the ferric salts. With the 
former the action is transitory and the hemorrhage 
may recur as soon as the action of the drug has 
worn away, while styptics, when effective, form a 
plug in the normal d'stended ])lood vessel. An- 
other point to be remembered, in this connection, 
is the fact that the absorption of a vasoconstrictor, 
following its continued or too liberal use, will 
cause a general rise of blood pressure and thus 
actually increase the flow of Ijlood at the bleeding 
points. 

At least one death following an injection of ad- 
renalin has been attributed to that drug. The pa- 
tient died eight days after adrenalin and cocain 
had been used in the extraction of a carious tooth. 

GLANDUL^Ti: SUPRAREXALES SlCCE. — U. S. P. — 

Desiccated Suprarenal Glands are directed to be ob- 
tained from the shcej) or ox. freed from fat, 
cleaned, dried and powdoivd. (Jnc part of desic- 
cated suprarenal gland represents a})proximatcly 
parts of fresh glands free from fat. 

Average dose: 0.25 gm. (4 grains). 

The alkaloid contained in the suprarenal glands 
lias been variously designated as epinephrin by 
.Vbel, suprarenin by Fiirth and adrenalin liy Taka- 
iiiine. The trade names that are now :i|)|ilied to 
the solutions of the same substance ai'c K'gion, and 
it seems very unfortunate indeed that the commit- 
tee on revision of the Pharmacopeia did not recog- 
nize-the alkaloidal substance in an official way and 
give it an official title. The only effect to be ex- 



200 PHARMACOPEIA AND PHYSICIAN. 

pected from the internal administration of the 
gland or its alkaloid is the local constriction that 
is noticed when it is applied to the mucous mem- 
brane. The solution of the alkaloid is without ef- 
fect on blood pressure when given by the stomach 
and when injected just beneath the skin it pro- 
duces practically no effect, except a local vasocon- 
striction. The dried gland is unsuited, of course, 
for intravenous use. 



CHAPTER IX. 

lEEITAXTS. EMOLLIENTS AND - DEMUL- 

CEXTS. 

There are so many substances which have been 
used as irritants under varying conditions that we 
can not attempt to do more than mention the more 
useful of the agents frequently employed for this 
purpose, together with some of the conditions in 
which clinical experience has shown them to be 
most beneficial. 

While the enn)lnyinent of counter-irritants is 
almost wholly empirical, the regions of the skin 
which Brunton has indicated for their use when it 
is desired to influence the internal organs corre- 
spond well with those which Head has shown to 
exhibit tenderness of the skin in connection with 
diseases of the same organs. 

Brunton directs the irritant to be placed over 
the larynx, ovaries or sciatic nerve for affections of 
tbose parts, over the ensiform cartilage for gastric 



ili^llll'liaiicc. ;l 


i()\c aiK 


lieldw tlie knee in rheuma- 


lisiii. i)\cr tlic 


)all (.r t 


le great toe (dorsal surface) 


in gout, bchiii 


1 llie e; 


V in facial neuralgia, at the 


base of the ln'; 


in ami 


laek of [he neck for cerebral 


airc.'ti(.ii^. ami 


alnii- t 


le (loi'sal ivujon lo all'eet the 


iiici'iis. 






Till- iniM(>l 


(if iiTil 


aiils is water oi- ,-aline solu- 


tinii used a- a 


halli. 


riie .-lioek of (lie cold water 


ai)])li('d to the 


skill an 


1 tho -light iri'iiation of tlu> 


subsequent Iri 


■li.m. pi 


eferahl}- wil li a coarse towel. 



202 PHARMACOPEIA AND PEYmCIAN. 

are followed by a reaction attended with a consid- 
erable and lasting stimulation. Very cold water 
may produce too great a shock in persons who are 
not robust, and the result will be depression, but 
there can be little doubt that baths are extremely 
beneficial when the temperature is so regulated 
that a healthy glow and a feeling of well-being 
succeed. It seems that the question of the useful- 
ness or the harm of cold baths, about which there 
has been so much contention, resolves itself into a 
question of individual experience. If a feeling of 
exhilaration, hut no subsequent depression, fol- 
lows the l)ath it is not harmful; if no such exhila- 
ration occurs, l)ut a distinct depression is observed, 
there can be but little doubt that the bath is doing 
harm. In such cases a slight increase in the tem- 
perature of the water, with a shorter time and 
more rubbing, may secure the benefits sought. The 
same person may require different conditions of 
temperature at different times, corresponding to 
variations in the general health. 

A mixture of salts is sometimes added to the 
bath to increase the slight irritant action. 

Even milder than the friction, which forms so 
essential a part of the bath, is the irritant action 
of the astringents, which have been discussed in 
Chapter VIII^ but these are followed by lessened 
irritation, hence they are not considered among the 
irritants. 

RUBEFACIENTS. 

Rubefaction is the result of a slight irritation of 
the skin. There is a slight increase in the exudate 
from the capillaries, and if the irritation be not 



HVBEFACIENTS. 203 

long continued this exudate is reabsorbed and the 
part speedily returns to the normal condition. 

While all irritants, mild and caustic, cause rube- 
faction, we shall first consider those which are 
used for that stage alone, and take up the vesi- 
cants, pustulants and caustics later. 

ALCOHOL, 

Alcohol alone, diluted with water or in the form 
of hanuimelis water, alcoholic tinctures, spirits or 
liniments, is used more frequently, perhaps, than 
any other mild irritant, with the possible exception 
of "the bath. 

Applications containing alcohol are useful in 
painful swellings, bruises and a great variety of 
minor complaints commonly treated in the house- 
hold without calling on the physician. 

While it is probably (|uite unnecessary, at this 
late date, to c-all iiarticular attention to the fact 
tliat there is a very great diiference between tlic 
official, or ethyl, alcohol and the various forms of 
wood, or methyl, alcohol, nevertheless the insidi- 
ously poisonous properties of the latter substance 
do not appear to be Well appreciated by the general 
j)ublic. The number of cases of blindness and of 
death that have been rcjiorted l)y Biiller and Wood^ 
amply demonstrate tliat cxi'ii tlic cxlci'iial use of 
aiiv toriii of wood alcohol is iiol ciitii'cly Tree from 
danger and that its use in any foi-m of mrdicinal 
pivparaiinn sIioiiM nn( \>r (Mumtcnan.vd or (olcr- 
alcJ. 

.\mong the numerous prejiarations of the 

1. 'I'irK jMiitNAi, A. M. A., Oct. 1, 8, 15, 22 nnd 20, 1904. 



204 PHARMACOPEIA AND PHYSICIAN. 

United States Pharmacopeia tliat have been used 
as topical applications, largely l)ecause of the rube- 
facient properties of tlic alcohol that they contain, 
we may enumerate: 

Aqua Hamameltdis. — U. S. P. — This prepara- 
tion, more popularly known as extract of witch- 
hazel, or distilled extract of witchhazel, is now, for 
the first time, included in the Pharmacopeia. 
While the preparation itself has been known for 
many years, and has been used extensively as a 
household remedy, it has never met with much 
favor on the part of the medical profession. The 
official preparation is directed to contain 15 per 
cent, of alcohol and should be free from methyl 
alcohol or any of its derivatives. 

TiNCTURA Arnica. — U. S. P. — Tincture of 
arnica represents 30 parts of the dried and pow- 
dered flower heads of Arnica montana in diluted 
alcohol. This preparation was at one time very 
popular with medical practitioners as a topical 
application in so-called "sprains" and in bruises, 
but is now seldom employed. The same is true of : 

TiNCTUUA Calendula. — U. S. P. — This prepa- 
ration represents 20 per cent, of the dried and 
powdered florets of Calendula o-fficinalis, the well- 
known marigold of our gardens. 

Probably the most objectionable feature in con- 
nection with the use of any of the official tinctures 
as topical applications is their tendency to stain. 
This objection is largely overcome by the use of 
the simple diluted alcohol, one of the numerous 
unofficial toilet waters or colognes, or by the use 
of one or the other of the official spirits. 



RUBEFACIEXTS. 205 

In addition to 

Spieitus Frumexti. — U. S. P. — Whisky, and 

Spiritus Vini Gallici.^U. S. P. — Brandy, the 
most frequently used of this class of prepara- 
tions is : 

Spiritus Campiior-t;. — U. S. P. — This is an 
alcoholic solution containing 10 per cent, of cam- 
phor. 

Spiritus Gaultheri^. — U. S. P. — This con- 
tains 5 per cent, of oil of gaultheria in alcohol. 

The most widely used, as well as the most pop- 
ular, of the mildly rubefacient liniments of the 
Pharmacopeia is : 

LiNiMEXTUM Sapoxis. — U. S. P. — Soap Lini- 
ment is variously known as liquid opodeldoc, cam- 
phorated soap liniment and camphorated tincture 
of soap. It contains 6 parts of soap, 4.5 parts of 
camphor, 1 part of oil of rosemary and 72 parts of 
alcohol with sufficient water to make 100 parts. 
This preparation has long been popular as a topical 
application and is not infrequently used as a ve- 
hicle for other more active rubefacients, sedatives 
and anodynes. 

A soinewbat tyi)ical compound liniment is the 

Linimextu:m Ciiloroformi. — U. S. P. — This 
is a simple nii.xture of 30 parts of chloroform with 
70 parts of soap liniment, and constitutes a very 
good illustration of the possible uses of soap lini- 
ment as a solvent or vehicle. 

CHLOROFORM. 

Chloroform is one of the more active rube- 
facients and the action quickly passes this stage if 
its use be continued. Chloroform readily dissolves 
fat, and, being very volatile, it penetrates quickly, 



206 PnARMACOPEIA AND PHYSICIAN. 

causing considerable redness and pain. A few 
drops of chloroform placed on a little absorbent 
cotton and applied over a painful joint, such as. a 
bunion, in such a way that evaporation of the 
chloroform is prevented, causes a good deal of pain 
but ofien affords speedy relief. It should not be 
applied in this way for longer than ten or fifteen 
minutes. Chloroform may be used as a counter- 
irritant by putting a few drops on cotton in a 
wide-mouthed bottle and applying the mouth of 
the bottle to the area to be treated for a few 
minutes at a time. 

Chloroform liniment, noted above, is much less 
painful, or not at all so in most cases, and is much 
slower in producing its effects. Chloroform lini- 
ment is usually directed to be applied to the af- 
fected part by being thoroughly rubbed in, thus 
securing the additional rubefacient action of fric- 
tion. It may, however, be more economically ap- 
plied, and is frequently quite as effective, if di- 
rected to be put on cotton, applied to the affected 
surface and then covered with several layers of 
cloth or otherwise prevented from evaporating too 
rapidly. 

VOLATILE OILS. 

All the volatile oils are irritant, their action 
ranging from that of the mild sandalwood or 
copaiba oil to the extremely irritant volatile oil of 
mustard or even the caustic action of oil of cloves. 
The use of the milder members of this series for 
their effects on the urinary tract will be mentioned 
in connection with diuretics. Some of the volatile 
oils, such as pennyroyal and savin oils, which are 
somewhat more irritant, have been employed to 



RUBEFACIENTS. 207 

produce abortion by reason of irritation of the in- 
testine and the consequent participation in the 
effects b}- the uterus. 

Of the official substances that are more or less 
closely connected with the turpentine group and 
are frequently used externally, we have : 

Oleum Eosmaeini. — U. S. P. — This is a vola- 
tile oil distilled from the fresh flowering tops of 
Rosmarinus officinalis and is one of the ingredients 
in the well-known soap liniment. 

Oleum Sabix^. — U. S. P. — Oil of Savin has 
been quite extensively used as a local irritant. It 
must be used with caution in order to guard 
against the tendency to act as a vesicant. 

Oleum TEREBiXTHiNiE.— U. S. P.— Oil of Tur- 
pentine is the volatile oil distilled from turpen- 
tine. Even as an external application it is not in- 
frequently used in the form of 

Oleum TEREBiNTHiNiE Eectificatum. — U. S. 
P. — This is identical with oil of turpentine in 
chemical properties, but it has a more agreeable 
odor. 

Terebinthina. — U. S, P. — This is officially de- 
scribed as the concrete olcoresin of Finns palustris 
and of other species of Pinus. 

Resixa. — U. S. P. — Eosin, resin or colophony, 
is the residue left after distilling off the volatile 
oil from turpentine. The last two articles, rosin 
and turpentine, arc interesting only as constitu- 
ents of several official preparations, of which the 
best known are: 

Cefjatum Eesin^e. — U. S. P. — This is a cerate 
containing 35 parts of rosin, 15 parts of yellow 
wax and •"»() jwirls f)f liTrd. 



208 PHARMACOPEIA AND PHYSICIAN. 

Ceratum Eesin^ CoisirosiTUM. — U. S. P. — 
This is a revival of the one-time official Deshler's 
salve. It contains rosin, yellow wax, prepared 
suet, turpentine and linseed oil. 

LiNiMENTUM Tebebinthin^.— ^U. S. P. — This 
is a solution of 65 parts of resin cerate in 35 parts 
of oil of turpentine. It has been recommended to 
be used in place of the oil of turpentine as a local 
application when the action of the latter might be 
considered as too irritating. 

Plasters of Burg-undy pitch, Burgundy • pitch 
with cantharides and of resin were formerly of- 
ficial. In practice these old-time resin plasters 
have long since been replaced by the more modern 
rubber-base plasters. 

CAPSICUM. 

Capsicum.— U. S. P.— The dried ripe fruit of 
Capsicum fastigiatum constitutes one of the most 
popular of the rubefacients used at the present 
time. Of the available official preparations we 
have : 

Fluidexteactum Capsici.— U. S. P.— This is 
made with strong alcohol. 

TmcTURA Capsici.— IT. S. P.— This is made 
with a mixture of 95 parts of alcohol with 5 parts 
of water, and represents 10 per cent, of the crude 
drug. 

Either of these preparations may be used diluted 
wdth alcohol or with soap liniment as a local rube- 
facient or irritant. 

Oleoresina Capsici.— U. S. P.— This is made 
bv extracting capsicum with acetone and may be 
used in the shape of the plaster, as noted above, or 



RUBEFACIENTS. 209 

in the form of the now popular mixture with pe- 
trolatum. 

The best representative of the rubefacient plas- 
ters now in use is the 

EiiPLASTRUM Capsici. — U. S. P. — This is di- 
rected to be made by applying a thin coating of 
oleoresin of capsicum to adhesive plaster. 

MENTHOL. 

. Mextiiol. — U. S. P. — This is a secondary alco- 
hol obtained from the oil of Mentlia piperita or 
other mint oils. 

Camphorated Chloral. — X. P. — This prepa- 
ration, quite popular in some parts of the United 
States as a local application, consists of equal 
parts of hydrated chloral and camphor. It is a 
thick, oily-looking liquid, which is extremely irri- 
tating. It may be diluted with the fatty oils, al- 
cohol or soap liniment. 

MUSTARD. 

Mustard is official as : 

SiNAPis Alba. — U. S. P. — White Mustard is 
the seed of Sinapis alha. 

SiNAPis Nigra. — U. S. P.— Black Mustard is 
the seed of Brassica nigra. 

Oleum Sinapis Volatile. — U. S. P. — This is 
a volatile oil obtained from black mustard (freed 
from its fatty oil) by maceration with water and 
subsequent distillation. 

Ciiarta Sinapis. — U. S. P. — jMustard Paper is 
directed to be made by coating rather thick, well- 
sized paper with a mixture of i-iibber cement and 
jiowdered bhu-k imistard wbicli bus been deprived 
of its fatty oil. 



210 PHARMACOPEIA AND PHYSICIAN. 

Mustard foot baths, containing one or two 
ounces of powdered or ground mustard, prefer- 
ably the black, thoroughly mixed with a gallon of 
warm water, are extremely useful for the relief of 
mild congestions of the head and of the gastro- 
intestinal tract. 

Prompt relief is often obtained in this way 
from headache and from pain in the stomach. In 
many cases, even mild attacks of indigestion show 
decided improvement almost immediately; the 
action is further accelerated if a hot-water bag 
is placed over the region of the stomach at the 
same time. 

The feet should be placed in the bath while the 
legs and feet are briskly rubbed with the mustard 
water for ten minutes or until the skin is red and 
some irritation is felt. The extremities are then 
rubbed dry with a coarse towel and wrapped in 
flannel or a blanket. When a slight degree of 
counter-irritation is desired for some time, a mus- 
tard poultice is employed. This is made by mixing 
one part of the ground black mustard with about 
five parts of flour (or ten parts of flour in the case 
of children), and mixing with enough water to 
form a mass. This is then spread on cheesecloth 
and applied at once. 

Mustard poultices have been largely replaced by 
the much more convenient mustard papers, which 
are dipped in tepid water and applied at once. 
They are prone to become worthless in damp cli- 
mates, since the absorption of moisture causes the 
slow development of the volatile oil, which then 
evaporates as fast as it is formed. With proper 
precaution, however, they may be preserved for a 



R UBEFA CIENTS. 2 1 1 

considerable length of time, and they will usually 
be found to afford the most convenient means of 
applying counter-irritation. 

Baths are used for their tonic and antipyretic 
action. The importance of friction — rubbing with 
a towel — after a bath can not be insisted upon too 
strongly, for the cold bath is potent for much harm 
in certain conditions, and the patient may pass 
into collapse if the proper technic is not observed 
in such cases. The antipyretic effect is only one, 
and perhaps even a minor, nse of the bath in 
typhoid fever. The tonic effect is absent, and 
much injury may be done when the cutaneous cir- 
culation, as evidenced by the redness of the skin, 
is not re-established after the bath. 

The regular use of the cold bath in the morning 
is very commonly supposed to lessen the tendency 
to catch cold. 

Mild ruljofacicnts, such as alcohol, soap lini- 
ment, tincture of arnica and hamamelis water, 
are used for bruises and painful swellings. They 
induce redness of the skin and temporary changes 
in the cutaneous circulation, but their use bej^ond 
this stage is not indicated in these affections. 

Oil of turpentine may be applied either in the 
form of the official liniment, diluted with a fatty 
oil., or it may be used in substances as a stupe; the 
latter is made by saturating a cloth with hot water, 
wringing it out and then dropping on it a little 
oil of turpentine, or dipping the moist doth into 
the oil of turpentine and again wringing it out 
and applying while still Avarm. 

Loc-al applications of this kind will lie rnuin'I 
useful in broncliitis. 



212 PHARMACOPEIA AND PHYHICIAX. 

Oil of turpentine is used internally, and it i.s 
applied as a stupe externally for the excessive 
flatulence often seen in typhoid fever; the lini- 
ment of turpentine is occasionally used as a pro- 
tective in the trcatinent of burns. 

Eesin cerate and the compound resin cerate are 
used to stimulate indolent ulcers such as are often 
seen after burns and scalds. 

Spirit of camphor may be used in much the 
same way, as well as by local application for head- 
ache and neuralgia. 

Chloroform, particularly in the form of the lini- 
ment, is useful as an anodyne in painful inflam- 
mations of the superficial tissues, but its evapora- 
tion must be prevented by an impermeable cover- 
ing, such as oiled silk. 

Capsicum plaster and other rubefacients are 
used for muscular rheumatism, neuralgia and 
colic. 

Menthol in cones, or in alcoholic or ethereal so- 
lution, is applied to the skin for headache and neu- 
ralgia. It causes a burning sensation and then 
that of coolness. 

Oleoresin of capsicum may be used as a rul)e- 
facient in the form of an ointment made as fol- 
lows : 

IJ. Oleoresinae capsici gr. xv 11 

Petrolati §iii 100| 

M. Ft. unguentum. 

Sig. : Use locally. 

Chloral camphor is an active rubefacient, but it 
is said never to cause blistering. It is used in 
toothache and in neuralgia. 



RUBEFACIENTS. 213 

HEAT. 

The uses of heat are so numerous and so well 
known that they scarcel}' require further mention 
at this time. We may be permitted to call atten- 
tion, however, to some of the various forms of 
cataplasms or poultices that are frequently used 
for their rubefacient or irritant properties. 

Among the official substances that are frequently 
used for the preparation of poultices we have : 

LiNUM. — IJ. S. P. — Linseed or flaxseed is the 
ripe seed of Linum usitatissimum. 

UL:\rus. — U. S. P. — Elm or slippery elm is the 
dried bark of VJnius fulva, deprived of its peri- 
derm. 

Carbo Ligni. — U. S. P.— This is charcoal pre- 
pared from soft wood and powdered. 

Poultices are ordinarily prepared by mixing the 
requisite amount of ground flaxseed, ground elm 
bark or other substance with enough boiling water 
to make a rather stifE mass, inclosing this in a 
piece of gauze or muslin and applying to the sur- 
face as hot as it can be borne. 

The rubefacient properties of a poultice may be 
increased by the addition of ground mustard, 
tincture of capsicum or of oil of turpentine. For 
removing fetor or to act as disinfectants, poultices 
may have added to them powdered charcoal, chlor- 
inated lime or tlie official solution of chlorinated 
soda. 

The present edition of the United Slates Pluir- 
macopoia has included one poultice, as : 

Cataplasma Kaolini. — U. S. P. — This con- 
sists of kaolin, glycerin and boric acid, with tliy- 
niol, methyl salicylate and oil of peppermint as 



•214 PHARMACOPEIA AND PHYSICIAN. 

admixture to give it a pleasing odor. This prepa- 
ration, like other poultices, is most efficacious when 
applied hot, but, as its action depends to a very 
great extent on the rubefacient properties of undi- 
luted gl3'cerin, due precaution should be taken to 
prevent the absorption of water or of watery vapor 
during the course of preparation or when heating 
it preparatory to applying. 

Practically the same preparation is being of- 
fered to the medical profession at the present 
time under a variety of trade names, and, while 
the combination undoubtedly has uses, many, if 
not all, of the positive claims that are made in con- 
nection with it are, to say the least, somewhat ex- 
aggerated, and the preparation should not be ex- 
pected to accomplish more than might reasonably 
be expected from an equivalent application of heat 
and mild rubefacients. 

One other point in connection with this particu- 
lar preparation that has been the cause of some 
controversy in the advertising pages of medical 
journals is the question of priority. This question 
may safely be ignored, as the mixture, apart from 
the flavoring ingredients, can not be said to be 
new. Glycerin magmas have been known and used 
for upward of half a century, and a formula for 
practically an identical preparation may be found 
in the Pharmaceutical Journal, London, for 
March, 1858. 

Formic acid has long been known and used in 
domestic practice as a rubefacient. In Germany 
it has found considerable favor in regular medicine 
and is official in the <Terman Pharmacopeia as a 
24 per cent, solution and also as a spirit of formic 



RUBEFACIENTS. 215 

acid, the latter containing 4 per cent, of the oflBcial 
solution of formic acid in a mixture of alcohol and 
water. 

lODIN". 

The official preparations of iodin that are used 
as rubefacients are: 

Liquor Iodi Compositus. — U. S. P. — This is 
Ijetter known as Lugol's solution ; it contains 5 per 
cent, of iodin and 10 per cent, of potassium iodid 
in water. 

TixcTURA Iodi. — U. S. P. — This is an alcoholic 
solution and contains 7 per cent, of iodin and 5 
per cent, of potassium iodid. 

UxGUENTUii Iodi. — U. S. P. — This contains 4 
per cent, of iodin and 4 per cent, of potassium 
iodid in a mixture of gh'cerin and benzoinated 
lard. 

Iodin in the form of the tincture or of the solu- 
tion is very common!}^ applied to the skin as a 
counter-irritant. Repeated applications produce a 
caustic effect, but the action is ver}^ easily con- 
trolled. One great disadvantage possessed by the 
official prejjarations of iodin is the dark staining 
of the skin. Numerous efforts have been made to 
obviate this by using so-called colorless tinctures of 
iodin, which are merely solutions of iodids.- It is 
much better to apply the iodin until sufficient irri- 
tation is caused and then remove the stain by 
washing with dilute solution of ammonia Avater or 
with a solution of sodium thiosulphate. 

A more modern preparation of iodin that pi'om- 
ises to replace the official preparations as an ex- 
ternal application is a sohition of iodin in sa- 
ponated petrolatum, a formula for which will be 



•21G PHARMACOPEIA AND PHYSICIAN. 

found in the latest edition of the National Formu- 
lary. 

Saponated petrolatum may he made by simply 
mixing : 

Liquid petrolatum 5ii 60 

Oleic acid Si 30 

Spirit of ammonia 5ss 15 

in the order enumerated, the only necessary pre- 
caution being to use preparations that correspond 
to the requirements of the United States Pharma- 
copeia. 

This simple saponated petrolatum will readily 
dissolve iodin up to 10 per cent, of its weight. A 
5 or 6 per cent, solution of iodin, however, will be 
found to be the most useful and not too irritating. 

Probably the greatest advantage possessed by 
a preparation of this kind is due to the fact that it 
causes little or no stain and may be readily washed 
off with soap and warm water. 

Saponated petrolatum may also be used for ap- 
plying a niim.ber of other rubefacients, such as 
camphor, menthol, chloroform, methyl salicylate 
and turpentine. 

The ordinary hot water bag has come into such 
general use for the application of heat that its 
mention is almost superfluous, but we will be per- 
mitted to remind the practitioner of the fact that 
this affords one of the most cleanly means of secur- 
ing rubefaction. Wakefulness due to cold feet 
may be prevented by the use of a hot water bag. 
Those covered with flannel or the plain bag 
Avrapped in cloth retain the heat much longer and 
are much less liable to produce burns. 

The temperature of the hot water bags should 



VESICANTS. 217 

bo regulated with care, as burns are not uncom- 
mon. The bag should not be used when it is too 
hot to be borne against the cheek. 

VESICANTS. 

Vesication is the result of greater irritation than 
that which merely causes rubefaction. The exu- 
date from the blood vessels is not absorbed^ but 
collects beneath the horny layer of the skin, which 
it can not penetrate, but which it separates from 
the layers beneath. Such collections of fluid are 
called vesicles or blisters, and the agents which 
produce them are termed cpispastics, vesicants or 
"blisters." 

If the vesicle is ruptured soon after it has 
formed, and the horny layer removed, it leaves a 
tender surface of the skin exposed ; this is irri- 
tated even by contact with the air, and, being eas- 
ily permeated, it is liable to infection, hence it is 
better to puncture the blister with a sterile needle 
inserted at the periphery; the fluid is allowed to 
escape while the loose layer of epidermis is left in 
place for protection imtil a new hard layer is 
formed. 

While there is some sensory stimulation, vesica- 
tion may occur, with merely an itching, from 
slowly acting agents which do not penetrate read- 

iiy. . . 

'J'hose agents wliicli, applied to the skin, cause 
vesication also cause an irritation of the mucous 
membrane, but, as the exudate escapes more read- 
ily from such surfaces vesication does not usually 
occur. 

Vesicants, and, in fact, all but the mildest of 



218 PHARMACOPEIA AND PHYSICIAN. 

irritants, such as heat, are contraindicted in the 
treatment of infants, in diabetics, who are prone 
to gangrene, and for the old and feeble. 

The internal use of irritants which are excreted 
b}^ the kidneys, and their external use if they are 
absorbed, as sometimes occurs with cantharides, 
are to be avoided in nephritis; in such cases 
stronger ammonia water may be used, but it is 
very painful. 

Mustard occasions so much pain before blister- 
ing, owing to the volatility of the oil of mustard, 
which, therefore, penetrates readily, that it is sel- 
dom used to produce an irritation beyond the stage 
of rubefaction. 

Cantharides contains cantharidin, which, though 
readily volatile at a higher temperature, is not 
much affected at the body temperature and does 
not rapidly penetrate the tissues, hence cantharides 
causes vesication with but little pain and is much 
the most popular of the vesicating agents. 

OFFICIAL PREPARATIONS OF CANTHARIDES. 

Cantharis. — TJ. S. P. — Cantharides, more 
popularly known as Spanish flies, is ofScially de- 
scribed as the thoroughly dried beetle of Can- 
tharis vesicatorm. The powder of cantharides. 
which is the form of the drug that is most fre- 
quently found in the shops, is grayish brown in 
color with shining green particles. It should con- 
tain few or no hairs. 

Ceratum Cantharidis. — U. S. P. — Canthar- 
ides Cerate, also known as blistering cerate or 
blistering plaster, contains 32 parts of powdered 



VE8ICANT>S. 219 

cantharides in a mixture of liquid petrolatum, 
yellow wax^ rosin and lard. Cantharides cerate is 
most frequenth' used in the form of a plaster, 
spread on the official adhesive plaster or some other 
suitable grease-proof material. 

CoLLODiini Cantharidatum. — U. S. P. — Can- 
tharidal Collodion represents the chloroform sol- 
uble portion of 60 parts of cantharides dissolved 
in sufficient flexible collodion to make 100 parts. 

Ti^^CTUEA Cantharidis. — IT. S. P. — This prep- 
aration represents 10 parts of cantharides ex- 
tracted with alcohol. It is not usually efficient as 
a vesicant, but is frequentl}- used externally as an 
irritant or rubefacient. 

The active principle of cantharides is not soluble 
in water, and, as the normal skin is usually covered 
with a thin film of perspiration, the necessary pre- 
cautions must be taken to have the blistering prep- 
aration come in contact with the dry skin. 

This is most readily accomplished by washing 
the part with soap and water and wiping it with a 
small amount of strong alcohol. In the case of the 
cerate or plaster the alcohol may be followed by a 
fatty oil, or, better stilk the surface of the plaster 
may be thinly coated with a coating of oil. 

In directing the use of a blister it should be re- 
incmberod that the resulting vesicle is usually 
larger than the plaster that has been applied, and 
the size of the latter, therefore, should be gauged 
accordingly. 

Cantharidal orillodion is simply painted on the 
surface, and is more ilcniily than the cerate. In 
using blistering collodidn Ihc same precaution of 



220 PHARMACOPEIA AND PHYSICIAN. 

thoroughly cleansing the skin, with soap and water, 
and alcohol, should be observed so as to insure 
vesication. 

Vesication usually ensues in about six hours 
after the application of the vesicant, .but a some- 
what longer period may elapse even in cases in 
which all the necessary precautions have been ob- 
served, and the physician should allow ample time 
before he concludes that the preparation is worth- 
less. 

Cantharides is prone to deteriorate with age, 
and one is often inclined to attribute the failure to 
cause blistering, to the worthlessness of the pro- 
duct, but even a faultless preparation may at times 
fail to produce vesication. 

The now widely used rubber-base plaster con- 
taining cantharides, although not official, has many 
points of advantage over the less cleanly extem- 
poraneous plaster made from the cerate. After 
preparing the surface of the skin, as indicated 
above, the plaster is smeared over with a thin 
film of oil and applied at once. After causing 
sufficient vesication it can be removed readily, and 
in this respect offers some advantage over the 
blistering collodion which continues to act until 
exhausted. 

While cantharides is commonly employed as a 
vesicant, it is sometimes applied for a shorter time 
to produce rubefaction, and its irritant action is 
also made use of in hair tonics, as it is supposed 
to stimulate the growth of hair. 

The following formula fairly represents the 
form of mixture commonly used as a hair tonic : , 



VESICANTS. 221 

IJ. Tineturae cantharidis fSii S 

Ammonii carbonatis 3i 4 

Spiritus myrcifB f 51! 60 

Aqua? q. s. ad f 5vi 200 

M. Sig. : Apply with brush, rubbing into the scalp 
after washing with tar soap. 

For this preliminary cloaning, or shampooing, 
the expensive Packer's tar soap has no advantage 
over the very much cheaper tar soap generally 
used by machinists for wasliing grease from the 
hands. 

Cantharides is commonly recommended for the 
treatment of baldness, but, like every other agent 
used for this purpose, it is usually ineffective. 

Where an oleaginous preparation, containing 
cantharides, is desired, the following may be used : 

B. Olei rieini 

Tincturse cantharidis, afi fSii 8 

Spiritus myrcia; f^i 30 

Alcoholis q. s. ad ..fgvi 200 

M. Sig.: Apply locally to scalp. 

The toxicology of cantharides is of some im- 
portance because the laity has an exaggerated idea 
of its efficiency as an aphrodisiac without a cor- 
responding appreciation of its Imrinfiil elfects on 
the kidneys. 

Poison oak has l)cen used as an irritant, but it 
is wholly unsuited for the purpose because of the 
extraordinary activity of the irritant principle, 
tlie uncertainty of its action, and the innl)i]ity to 
control it, wliicli render it I'ai' infciMor to many 
otlier available irritants. 

It is of considerable toxicologic interest because 
of the frequency with which accidental poisoning 
occurs, either from handling it or merely coming 
into the immediate neighl)orhood. since even dust 



222 PHARMACOPEIA AND PHYSICIAN. 

particles ma}' carry enough of the extraordinarily 
active fixed oil, toxicodendrol or glucoside which, 
according to Acree and Syme, is the active sub- 
stance on vrhich the action depends, to poison sus- 
ceptible persons. 

Toxicodendrol penetrates the skin very easily 
and is, therefore, difficult to remove. Even bland 
oils are to be avoided in the treatment of poisoning 
by it, since they but serve to dissolve and spread 
the poison, the same being true, of course, of oint- 
ments, vaselin and cerates. 

In treating a case of rhus poisoning as much^as 
possible of the poison should be removed by re- 
peated washing with soap and fresh portions of 
warm water, after which a paste of soap or a so- 
lution of lead acetate is applied. If vesicles form 
they should be opened with care and the liquid 
received on absorbent cotton or a powder such as 
baking soda, since it would but extend the irrita- 
tion if the exuding liquid were allowed to spread 
over the surface of the skin. 

S}Tne used a solution of potassium perman- 
ganate in numerous cases of intentional and acci- 
dental poisoning on himself, and found it uni- 
formly effective. He rubbed a 1 per cent, solu- 
tion of the permanganate into the vesicles, whereby 
the poison was destroyed by oxidation. He found 
it very much more eft'ective when the part affected 
was immersed for a time in a hot solution of the 
permanganate. The resulting staining of the skin 
is a small matter compared to the discomfort of 
the poison in severe cases, but this stain may be re- 
moved with a solution of oxalic acid. 

The place should then be carefully washed with 



PUSTULANTS. 223 

soap and warm water to remove even traces of the 
fluid from the vesicles, and the soap paste or the 
solution of lead acetate applied. 

Fluidextract of grindelia robusta, diluted with 
water, or with a saturated solution of sodium bi- 
carbonate (about 6 per cent.) has had a special 
reputation as a wash for the treatment of poison 
oak. 

PUSTULANTS. 

Pustulants are those irritants which give rise to 
pustules instead of vesicles. The pustulants ap- 
pear to be unable to affect the skin through the 
horny layer as a rule, but can only penetrate the 
orifices of the glands. They are much less fre- 
quently used than the rubefacients and the vesi- 
cants. 

As tartar emetic is not irritant except in acid 
solution it has been suggested that it is decom- 
posed by acids in the cutaneous glands, and there 
produces pustulation. 

Croton oil owes its irritant action to crotonoleic 
acid, which exists mainly in combination as a fat. 
This fat is not affected by the gastric juice, but 
is split up in the intestines and the crotonoleic acid 
is then able to exert its violent irritation result- 
ing in purgation. 

Applied to the skin croton oil causes pustuhi- 
tion. It is not now so much used externally or 
internally as it was fonncrly. 

(JI-FrCI.VL PUSTULANTS. 

Antimomi kt Potassii Tartras. — U. S. P. — 
Antimony and Potassium Tartrate, more common- 
ly known as tartar emetic, is usually seen as a 



224 PHARMACOPEIA AND PHYSICIAN. 

white granular powder, without odor, and having 
a sweet, afterward disagreeable metallic taste. It 
is soluble in about 16 parts of cold water, but is 
much more readily soluble in hot water. 

Antimony and potassium tartrate may be used 
externalh', as a pustulant, either in the form of 
the powder, in aqueous solution, or in the form of 
an ointment. The German Pharmacopeia contains 
a formula for the latter preparation that appears 
to be quite popular on the continent of Europe. 
This is a simple mixture of 20 parts of antimony 
and potassium tartrate, with 80 parts of petrola- 
tum. 

Because of its irritant action tartar emetic pro- 
duces nausea or emesis^ when taken internally, ac- 
according to the amount employed. It is much more 
frequently used as a nauseant than as an emetic, 
and least often as a pustulant; for the latter pur- 
pose it will be found to be preferable to use it in 
the form of an ointment, similar to the one re- 
ferred to above, simply rubbed on the skin. 

Oleum Tiglii. — U. S. P. — Croton oil is de- 
scribed as a fixed oil expressed from Croton Tig- 
li'um. It occurs as a pale yellow, or brownish yel- 
low, viscid, fluorescent liquid, having a mild, oily, 
afterward acrid and burning taste. In eastern 
countries croton oil appears to have been known 
from a very early period. It was known in Europe 
several centuries ago, but fell into disuse and was 
reintroduced there with several other drugs from 
India, about 1813. 

CAUSTICS. 

Caustics are irritants which either cause violent 
inflammation, resulting in necrosis, or dissolve the 
tissue bv direct chemic action. 



CAUSTICS. 225 

Caustics may be used to iDroduce counter-irrita- 
tion alone, to remove exuberant or diseased tissue 
or, in diluted form, to stimulate non-granulatin^ 
surfaces. * 

Apart from the use of the thermocautery in 
surgery, that of lunar caustic for exuberant 
growths and non-granulating tissues, and of ar- 
senic for the destruction of the nerves of teeth, 
caustics are not very widely used at the present 
time. 

The number of substances possessing a corrosive 
action is, of course, very great, but many of them 
are not suited for therapeutic use, thus the strong 
alkalies, such as caustic potash and caustic soda, 
dissolve the tissue and penetrate deeply, hence 
their action is not easily controlled, besides they 
are very painful. 

Potassium hydroxid, better known, perhaps, as 
potassa, is sometimes used to soften and to remove 
the callus of corns and warts. 

The action of silver nitrate, and of copper sul- 
phate, in the form of molded sticks, or cones, is so 
easily controlled that they are very commonly used. 

Argenti Nitras.— U. S. P.— Silver Nitrate, 
which appears to have been known to Geber as 
lapis infoi-nalis in the eighth century, has been 
used extensively. It occurs as colorless crystals, 
which are freely soluble in about one part of water 
and melt or fuse at 200° C. (392° F.). This 
hitter feature is taken advantage of in making the 
ofHcial forms of fused silver nitrate, and is also of 
advantage in forming extemporaneous prcpai'a- 
tions, for local application, by melting or fusing 



226 PHARMACOPEIA AND PHYSICIAN. 

silver nitrate on to suitable metallic instruments 
such as sounds. 

Argenti Nitras Fusus. — U. S. P. — Molded 
Silver Nitrate contains about 95 per cent, of silver 
nitrate, with a small amount of silver chlorid, 
which is added to make the sticks tough and 
fibrous. 

Argenti Nitras Mitigatus. — U. S. P. — Miti- 
gated Silver Nitrate is composed of one part of sil- 
ver nitrate and two parts of potassium nitrate 
fused together. 

CuPRi Sulphas. — U. S. P. — Copper Sulphate 
or blue vitriol occurs as large, transparent deep 
blue crystals. For external use these crystals maji 
be rasped or filed into suitable shape, and are then 
used in very much the same way as are the sticks 
of silver nitrate. 

The various uses of these agents are so well 
known that they scarcely require extended treat- 
ment here. 

When the lunar caustic is used on exuberant 
granulations care should be taken to avoid bring- 
ing it into contact with the newly formed skin, 
which is recognized only as a bluish line, since this 
occasions pain and is, of course, destructive of the 
very object it is intended to promote. 

arsenic and zinc chlorid. 

Arseni Trioxidum. — U. S. P. — Arsenic Tri- 
oxid, also known as arsenous acid and as white 
arsenic, occurs most frequently as an odorless and 
tasteless white powder, that is but slowly soluble in 
about 100 parts of water. 

ZiNCi Chloridum. — U. S. P. — Zinc Chlorid oc- 
curs as a white granular powder or a porcelain- 



CAUSTICS. 227 

like mass. It is freely soluble in water, but tlie 
solution decomposes, on long standing or boiling, 
depositing a basic salt. 

Arsenic and zinc chlorid have been used to de- 
stroy cancerous growths. Arsenic, particular!}^, 
has been widely used as the active constituent of 
various cancer cures that have been proposed by 
regular, as well as irregular, practitioners. Its 
action is very slow, and, therefore, it can be readily 
controlled, Ijut it occasions considerable pain. 
Arsenic may be employed in the form of powder, 
as an ointment, either with lard or petrolatum, 
or as a paste. In the latter case the arsenic is 
suitably diluted with cither starch or powdered 
althaea, and subsequently mixed with water to 
which a trace of gum or mucilage has been added. 
At present arsenic is frequently used for the de- 
struction of the nerves in carious teeth. 

Zinc chlorid is seldom used for its local corro- 
sive action. It may be used in aqueous solution or 
fused on to suitable metallic instruments, much as 
silver nitrate is employed. 

Mercuric chlorid is the most corrosive of the 
metallic salts, but it is too toxic to permit of its 
general employment for its local caustic action. 

SOME OTHER OFFICIAL CAUSTICS. 

AciDUM NiTRicuM. — U. S. P. — The official 
Nitric Acid contains G8 per cent, by weight, of 
ai)Solutc nitric acid, and occurs as a colorless, 
fuming liquid that is very caustic and corrosive. 

Liquor llYDitAnoYRi Nitratis. — U. S. P. — So- 
lution of IMercuric Nitrate occurs as a clear, nearly 
colorless liquid, having a faini ddni' of nitric acid 
and a strongly acid reaction. It should contain 



228 PHARMACOPEIA AND PHYSICIAN. 

about 60 per cent, of mercuric nitrate and about 
11 per cent, of free nitric acid. 

Unguentum Hydrargtri Nitratis. — U. S. P. 
— Ointment of Mercuric Nitrate is made by dis- 
solving 7 parts of mercury in 10.5 parts of nitric 
acid and adding this solution to 76 parts of lard 
that has previously been partially decomposed by 7 
parts of nitric acid, and continuing the heat, if 
necessary, until the reaction is completed. The re- 
sulting ointment should have a bright yellow color, 
whence its popular name, "citrine ointment." 

Unguentum Hydrargyri Ammoniati. — U. S. 
P. — The Ointment of Ammoniated Mercury is 
now directed to be made by mixing 10 parts of am- 
moniated mercury with 50 parts of white petro- 
latum and 40 parts of hydrous wool fat. 

Chromii Trioxidum. — U. S. P. — Chromium 
Trioxid, commonly called chromic acid, should be 
kept in glass stoppered bottles and great caution 
should be observed to avoid bringing it in contact 
with organic substances, such as cork, tannin, 
sugar alcohol, etc., as dangerous accidents might 
result because of its violent action as an oxidizing 
agent. 

Nitric acid is a popular domestic remedy for 
the removal of warts. The surrounding surface 
should be thickly covered with petrolatum and a 
single drop at a time of the acid applied to the 
excrescence. 

Solution of mercuric nitrate is sometimes used 
for chancres and where it is desired to destroy the 
tissue. 

The ointment of mercuric nitrate is used more 
frequently than the solution ; it is not so corrosive, 



EMOLLIENTS. 229 

but is an active stimulant in sj^philitic ulcers; it 
is also used in parasitic diseases of the skin. In 
the undiluted state it is too caustic for general use 
and is, therefore, usually diluted with lard. Oint- 
ment of ammoniated mercur}^ is used in much the 
same conditions as the ointment of the mercuric 
nitrate. A 20 per cent, solution of chromium 
trioxid is sometimes used for the removal of warts 
as well as for condylomata. Its use is not without 
danger and it should not be applied to a large 
surface. 

EMOLLIENTS. 

The word emollient is derived from emollio, to 
soften; demulcent comes from demulc&o, to 
smooth. Since the same agent is usually demulcent 
as well as emollient, the term to be used depends 
on the tissue to which the agent is to be applied, 
rather than on the medicinal agent itself. Mucous 
membranes rarely require softening, but an in- 
ilamed skin is frequently hard and rough, we 
therefore speak of applying demulcents to mucous 
membranes and emollients to the skin. 

Xot only bland oily substances and fats, but 
mucilages and diluted glycerin act as emollients. 
Glycerin, \\\\v\\ diluted with water, and rubbed 
into the skin, prevents it from becoming dry and 
liai'sh, and the tendency to crack. Oils and fats 
penetrate the skin and render it soft. 

SOME OFFICIAL EMOLLIENTS. 

AuEPS Lan^e Hyduosus. — U. S. P. — This prep- 
aration, formerly called lanolin, is tiie purified fat 
of the wool of sheep {Ovis aries)^ mixed with 
about 30 per cent, of water. 



230 PHARMACOPEIA AND PHYSICIAN. 

Glycerinum. — U. S. P. — Glycerin or glycerol 
is a clear colorless liquid of syrupy consistence, ob- 
tained by the decomposition of vegetable or animal 
fats. Anhydrous glycerin is slightly rubefacient, 
but when diluted it is, as previously stated, an effi- 
cient emollient, 

MuciLAGO Tragacanth^. — U. S. P. — Mucilage 
of Tragacanth contains 6 per cent, of tragacanth 
and 18 per cent, of glycerin, with enough water to 
make 100 parts. 

Petrolatum. — U. S. P. — Under this general 
heading the present Pharmacopeia includes what 
was formerly known as hard and soft petrolatum. 

Petrolatum, a mixture of hydrocarbons, of the 
methane series, is obtained from petroleum and 
should be of about the consistence of an ointment. 
The oflficial substance may vary in color from yel- 
low to light amber and have a melting point vary- 
ing from 45° to 48° C. (113° to 118.4° F.). In 
addition to this, which is popularly known as yel- 
low petrolatum, the Pharmacopeia also includes : 

Petrolatum Album. — TJ. S. P.^This is a 
white unctuous mass, of about the consistence of 
ointment, that otherwise has the same chemical 
and physical characteristics as petrolatum. 

Petrolatum Liquidum. — U. S. P. — Liquid 
Petrolatum is a colorless or only slightly yellowish, 
oily, transparent liquid without odor or taste, but 
giving off, when heated, a slight odor of petrola- 
tum. 

Of the vegetable oils that are useful as demul- 
cents, it will suffice to enumerate : 

Oleum Amygdala Expressum. — U. S. P. — 
Expressed Oil of Almonds. 



EMOLLIENTS. 231 

Oleu:m Gossypii Semixis. — U. S. P. — CottoD 
Seed Oil. , 

Oleum Oliv^.— U. S. P.— Olive Oil. 

0leu3j: Theobromatis. — ^TJ. S. P. — Oil of 
Theobroma, so-called "cocoa" butter. 

Of the several official preparations used as 
emollients, we may mention: 

Ceratum. — U. S. P. — Cerate consists of 30 
parts of white wax, 20 parts of white petrolatum 
and 50 parts of benzoinated lard. 

Unguentum. — U. S. P. — Ointment consists of 
20 parts of white wax and 80 parts of benzoinated 
lard. These two preparations are used as emol- 
lients or as the bases for active medicinal sub- 
stances. 

LiNiMENTUM Calgis. — U. S. P. — Lime Lini- 
ment, or Carron oil, so called from the name of the 
iron works in England where this preparation had 
its origin, consists of equal parts of lime water and 
linseed oil. It has long been in use as a popular 
dressing for superficial burns and constitutes a 
readily applied and effective non-antiseptic remedy 
that rapidly allays the accompanying pain. If 
there has been extensive destruction of tissue, this 
remedy should be avoided, as it is not alone diffi- 
cult to remove, but also forms a covering beneath 
which bacteria may proliferate safe from the reach 
of antiseptics. 

Unguentum AqujE KosiE. — U. S. P. — Oint- 
ment of Rose Water, or, as it is usually called, cold 
cream. This ointment consists of a mixture of 
spermaceti, white wax, expressed oil of almonds, 
sodium borate and rose" water, and in one form or 



232 PHARMACOPEIA AND PHYSICIAN. 

another has been the most popular of the mild 
emollients from the time of its originator, Galen. 

Emollients are used for the protection of in- 
flamed skin against irritants, the choice depending 
on individual preference or convenience rather 
than on the nature of the drug. Thus mucilage of 
tragacanth, ointment of rose water and petrolatum 
differ widely in their phj^sical properties, but they 
are all used for chapped hands, sunburn, and to 
soften the skin when it is rough and hard. 

The bland oils and ointments penetrate the skin 
more readily than does diluted glycerin, and, 
therefore, they are to be preferred as emollients 
when they are also to serve as carriers of medicinal 
substances intended for absorption. 

Diluted glycerin is an excellent agent for soft- 
ening the skin, but is somewhat irritant, and when 
the sensitive layers of the skin are exposed, a bland 
oil or ointment, such as cold cream, is to be pre- 
ferred. 

To prevent chapping of the skin when it is ex- 
posed to the wind, to alternate wetting and drying, 
or to irritants, tlie mucilage' of tragacanth, pre- 
ferably mixed with an equal portion of glycerin, 
will be found useful. The exposed surface is 
washed with warm water and soap to soften the 
akin, and while it is still moist, but not wet, a 
little of the mucilage, or the mixture of mucilage 
and glycerin, is rubbed into the surface until the 
latter feels smooth. Instead of the tragacanth 
mixture the following may be preferred by some, 
but it is somewhat irritant to very delicate skin : 

One ounce of glycerin soap is reduced to shav- 
ings and dissolved with the aid of gentle heat, in 



EMOLLIENTS. 233 

half a pint of a mixture of equal parts of gh'cerin 
and water. This mixture solidifies on cooling, and 
a piece about twice the size of a pea is to be rubbed 
into the moist skin as often as ma}- be necessar}-. 
Those who work with irritant or corrosive chemi- 
cals will find this an excellent agent for keeping 
the hands soft. 

A liquid preparation that has met with consid- 
erable favor may be made by mixing ten parts of 
tincture of benzoin, fifty parts of water, and forty 
parts of glycerin. To secure a homogeneous mix- 
ture the water should be gradually added to the 
tincture of benzoin, and the glycerin added to this 
mixture. If the resulting mixture should still be 
irritating the amount of glycerin may be further 
reduced, with a corresponding increase in the 
quantity of the water. If rose water were substi- 
tuted for the water in the above formula the re- 
sulting mixture would simulate some of the well- 
known and widely-advertised proprietary toilet 
preparations of glycerin and roses. 



CHAPTEE X. 

LOCAL ANESTHETICS AND ANODYNES. 

The introduction of cocain marked a decided ad- 
vance in the production of local anesthesia. 

Previous to that, freezing the part by immersion 
in a mixture of salt and snow^ or shaved ice, or by 
spraying with ether or other volatile liquid, was 
used, and, while a procedure of this kind does pro- 
duce complete anesthesia, the pain experienced 
during the freezing and thawing greatly exceeds 
that which would be caused by such a simple 
operation as opening an abscess or the removal of 
a small foreign body, such as a splinter or piece of 
glass, when readily accessible. It is because of the 
inherent dread which the average person has of 
the surgeon's knife, that he will undergo suffering 
akin to that with which he is familiar, rather than 
endure a lesser one which seems dreadful because 
it is unfamiliar. 

It is also true that the injection of cocain some- 
times causes more pain than would the operation 
for which it is given, and, since surgical operations 
have become so much more common than they were 
formerly, many adults willingly bear the brief, 
sharp pain of a simple incision, rather than resort 
to cocain, 'which has come into a certain disrepute 
because of the abuse of it by its victims, the ma- 
jority of whom have become such through the use 
of supposedly harmless nostrums pretending to be 



Local AyESTHETics. 235 

valuable remedies for hay fever and other minor 
affections. 

Cocain, which is methyl-benzoyl-ecgonin, shows 
a certain chemical analogy to atropin and aconitin, 
which reseml)le it somewhat in their action on 
sensory nerves, and it is also related to phenol 
through the benzoyl group, since benzoic acid dif- 
fers from phenol only by having a COOH group in 
place of the OH of the phenol. The anesthetic 
action of phenol is second only to that of cocain. 

Aside from the systemic effect, which Ave need 
not fully detail here, cocain paral3'zes sensory nerve 
endings with which it comes in contact and even 
nerve trunks when in sufficient concentration; if 
the solution is sufficiently dilute and the action not 
too long continued, the nerve endings rapidly re- 
turn to normal (the nerve trunk more slowly), 
when the application is discontinued and the co- 
cain removed by absorption into the general circu- 
lation, or evacuated. 

It is denied that cocain has a specific action on 
the sensory nerve endings, their more exposed situ- 
ation explaining the more prompt effect on them. 

When a fairly strong solution (3 per cent.) is 
injected into the area about a nerve trunk, or an 
even weaker solution, 2 per cent., within the nerve 
sheath, both sensory and motor paralysis occur in 
about fifteen minutes, affecting, of course, the en- 
tire distribution of the nerve, the effect lasting for 
some hours after intraneural injection. 

Since aqueous solutions are not absorbed from 
the unbroken skin, they must be injected beneath 
the epidermis, at least, in order that they may 
come into actual contact with the nerve ends. 



236 PHARMACOPEIA AND PHYSICIAN. 

When the solution is injected deeply into the 
muscular tissue the greater part of it passes into 
the general circulation and is lost so far as local 
action is concerned. To avoid this, it is better to 
inject the solution between the layers of the skin, 
at the same time limiting the circulation in the 
part as much as possible by compressing the blood 
vessels, preferably with a rubber band or other 
tight bandage. 

Practically, the same object may be achieved by 
the use of a solution of the alkaloid of the supra- 
renal gland immediately preceding the injection of 
the solution of cocain. The injection of the solu- 
tion of sujjrarenal alkaloid (epinephrin, adrenalin 
or one of the other trade preparations) causes a 
local vasoconstriction that in turn prevents tlie 
rapid absorption of the cocain solution into the 
general circulation, and also prevents, for the time 
being, the excessive hemorrhage that is so objec- 
tionable in minor operations. When it is neces- 
sary for the solution of cocain to diffuse through 
a part, a moment should elapse after the injection 
before applying the constricting bandage. 

The combined use of suprarenal alkaloid and 
of cocain has proved to be of particular advantage 
in the eye and in the nose. One reason, and prob- 
ably the most weighty one, is to be found in the 
fact that normal mucous surfaces have a tendency 
to absorb cocain very rapidly. 

When cocain is applied to mucous membranes, 
either in powder or in solution, it causes its local 
effects for a short time and is then absorbed, pro- 
ducing its systemic action. Herein lies one of the 
chief sources of danger of the many so-called hay- 



LOCAL AXESTHETICS. 237 

fever remedies, which virtually consist of cocain 
with some diluent powder, such as sugar of milk, 
and are intended to induce and to continue the 
trul}- terrible cocain habit. 

Owing to the brief action and rapid absorption. 
frequent repetition is necessarv to secure relief in 
"colds" and the user is peculiarl}- liable to become 
addicted to the habit which, in its baneful effects, 
is not exceeded, perhaps, in the whole range of 
drug addiction, not even excepting alcoholism. As 
a matter of fact, many of the so-called hay-fever 
nostrums are intended primarily for supplying 
those who are already victims of the habit and who 
would find difficulty in buying the drug imdcr its 
correct name. This practice may be said to con- 
stitute a disgraceful example of the lack of proper 
control of the nefarious nostrum traffic by the law. 

We should be particularly careful to warn pa- 
tients and others against the insidiousness of this 
type of self-medication that our skirts may at 
least be kept clean in connection witli t])is one 
phase of the evil. 

Cocain in solution i.s readily decomposed on 
l)oiling, but if the solution lie made with sterile, 
cold water there, will be little cause to anticipate 
sepsis from its injection with the usual precau- 
tions. The solution may be sterilized, however, 
by heating to 80° C. (176° F.) for half an hour at 
a time on two successive days, care being taken to 
cliniiiiatc all ])0ssible contaminations of even a 
ti'ac(.' of alkali. 

I'hicain and .slo\ain have the advantage of resist- 
ing decomposition hy boiling, but, as just sug- 
gested, the disaiKanliiLic ])ossessed hy cocain is 



238 PHARMACOPEIA AND PHYSICIAN. 

more apparent than real, and the general action of 
cocain, particularl}^ its possible complications, 
being well known, that drug, no doubt, will con- 
tinue to hold first place as a local anesthetic, ex- 
cept where the ubiquitous detail man succeeds in 
frightening the more timid members of the profes- 
sion into an exaggerated idea of the various dan- 
gers attending the proper use of the official article, 
and into a corresponding credulousness concerning 
the entire harmlessness of the particular substitute 
in which he is interested. 

Cocain, when dropped into the eye, or taken in- 
ternally, causes an incomplete dilatation of the 
pupil by stimulating the sympathetic nerve, reac- 
tion to light being maintained, differing therein 
from atropin, which abolishes this reflex. 

OFFICIAL PREPARATIONS OF COCAIN. 

Cocaine Hydrochloridum. — IT. S. P. — Co- 
cain Hydrochlorid, the most widely used prepara- 
tion of cocain. is officially described as the neutral 
hydrochlorid of an alkaloid obtained from several 
varieties of coca. It occurs as colorless, trans- 
parent crystals or a white crystalline powder. It 
is soluble in less than one part of cold water and in 
2.6 parts of alcohol, but is insoluble in petroleum 
benzin and in ether. 

CocAix.— U. S. P.— This is a^i alkaloid oh- 
tained from several varieties of coca, resembling 
cocain hydrochlorid in many of its properties, but 
being only slightly (1-GOO) soluble in water. It is 
soluble in 5 parts of alcohol and even more soluble 
in ether and in petroleum benzin. The alkaloid 
cocain is also soluble in about 13 parts of olive oil 



LOCAL ANESTHETICS. 239 

and it, or the oleate, is to be used in making solu- 
tions of cocain in oil. 

Oleatum Cocain,^.— U. S. P.— Oleate of Co- 
cain contains o per cent, by weight of cocain in a 
mixture of oleic acid and olive oil. 

The liquid preparations of coca, the fluid extract 
and the wine, are never iised externally, although, 
if applied to the mucous surfaces, or to the abraded 
skin, their use would not be devoid of danger, from 
the absorption of the contained cocain, and other 
coca alkaloids. 

Cocain is used locally on mucous membranes to 
allay irritation and inflammation as in hay fever, 
but it should be used very guardedly and not be 
too long continued. It is very much less useful in 
this condition than was formerly supposed and it 
has been very lai-gely replaced Ijy the now com- 
monly used alkaloid of the suprarenal gland, 
which, it is claimed, allays the inflammation 
equally well and has the marked advantage of not 
inducing the habit. 

Solution of cocain is very commonly injected 
hypodermically, to produce local anesthesia during 
such slight operations as the evacuation of al)- 
scesses, the removal of splinters, bullets, and other 
foreign bodies. 

W'iien there is considerable inflammation and ex- 
treme tenderness, stronger solutions ai-c r('(|uired 
than when a healthy surface is to be incised. In 
the former case, a syringe having a Imig, liiu^ 
needle, is filled with a 4 per cent, solution of co- 
cain hydrochlorid, the needle is then iiiscilcd ob- 
liquely, or almost parallel with the surface, be- 
tween the layers of the skin, ])eyond the zone of 



240 PHARMACOPEIA AND PHYSICIAN. 

increased tenderness, and a small drop of solntion 
is forced beneath the epidermis; a white spot is 
seen in a moment and the needle is then advanced 
through that toward the more tender area without 
removing the point of the needle from beneath the 
epidermis; with each advance a drop of the solu- 
tion is injected. When the needle has been passed 
under the epidermis for its full length, it is with- 
drawn and the point inserted into the most ad- 
vanced blanched area; in this way, using a curved 
needle, a complete circuit may be made of the seat 
of inflammation. The object of injecting the solu- 
tion between the layers of the skin is to secure 
anesthesia with a minimum of absorption into the 
general circulation. 

The psychic effect on the patient of having pain- 
less injections made into such an extremely tender 
region tends to allay the nervous dread of the 
knife, which is a more important factor than we, 
who are accustomed to seeing pain, are apt to 
realize. 

The injection of a solution of cocain into the 
hand is apt to prove ineffective when the trouble 
is deep seated, as in palmar abscess, and in such 
cases it is better to inject a small amount of a 2 
or 3 per cent, solution around or into the nerve 
trunks in the forearm. 

The injection of strong solutions into nerve 
trunks has given rise to much trouble and it is 
preferable, therefore, to try to secure the effects 
from weak solutions. 

Kast and Meltzer have very recently shown that 
the abdominal organs are capable of exhibiting 
sensations of pain, and that these sensations are 



LOCAL AyESTHETIGS. 241 

increased ])y inflammation, but that they may be 
completely abolished by a subcutaneous injection 
of cocain. 

Anesthesia involving all the body below the site 
of the injection may be secured by injecting about 
ten or fifteen minims of a 2 per cent, solution of 
cocain hydrochlorid into the subarachnoid cavity 
through a sterilized platinum needle which is in- 
serted at the side of the fourth lumbar vertebra. 
The patient must be placed in a sitting position, 
in order that gravity may not favor the passage of 
the solution up to the medulla. 

This method of using cocain (or any other drug) 
is attended with so much danger that it is not 
justifiable except when, for some reason, general 
anesthesia is not practicable. 

The anesthesia is induced in ten or fifteen min- 
utes, with cocain, but its duration is very variable, 
lasting from half an hour to five hours. 

When the application of a constricting band is 
not feasible the previous injection of a solution of 
the suprarenal gland, as previously suggested, will 
delay the absorption of the solution of cocain into 
the general circulation. It should be remembered, 
however, that the use of a vasoconstrictor only de- 
lays and does not prevent the absorption of the co- 
cain. When a large amount of the cocain solu- 
tion is necessary it will probably be preferable 
to use the infiltration method as proposed by 
Schleich. It is difficult to see what advantage 
is to be gained by the addition of morphin to a 
solution instead of directing the injection of the 
desired amount at once so as to secure its sys- 



242 PHARMACOPEIA AND PHYSICIAN. 

temie effect. Schleich recommended solutions 
containing from 0.01 gm. (1/6 grain) to 0.2 gm. 
.(3 grains) of cocain hvdrochlorid and from 0.005 
gm. (1/12 grain) to 0.25 gm. (I/2 grain) of mor- 
phin hvdrochlorid in 100 c.c. (3 fluid ounces) of 
0.2 of 1 per cent, solution of sodium chlorid to 
which was added one-fourth of a drop of phenol. 

Strong solutions of cocain should not be used in 
carious teeth, and only small amounts of the weak 
solution. One or two drops of a 1 per cent, solu- 
tion often affords relief from toothache. 

Cocain is sometimes applied to hemorrhoids to 
lessen the pain and it may be said that its local use 
is much more rational than is that of opium, since 
the alkaloid morphin has no local analgesic or 
vasoconstrictor action^ a fact to be remembered 
when prescribing urethral injections, and lotions 
for inflamed surfaces of the skin. 

Cocain has also been used, in small doses, to re- 
lieve nausea. It may be given alone or with other 
antiemetics. The following is an example of a 
combination with cerium oxalate, the latter being 
used empirically : 

IJ. CocairtfE liydrochloridi gr. i 06 

Cerri oxalatis gv^ xvi 1 

Aquae aurant. flor f^i 30 

M. Sig. : Shake the mixture and give one teaspoonful 
every half hour when needed. 

Many substitutes for ' cocain, of greater or less 
merit, have been brought forward by manufac- 
turers, and, while they have been widely heralded 
as being superior to cocain, they are not free from 
disadvantages; though the manufacturers have 
not; as yet, devoted much time or space to the 



LOCAL AXESTHETICS. 243 

exploitation of these several disadvantages or 
dangers. Their further consideration, however, 
does not belong in a treatise on the Pharmacopeia. 
Hydrocyanic acid is a general protoplasmic 
poison rapidly causing paralysis and death to any 
tissue to which it is applied. It induces anesthesia 
when applied to mucous membranes, but owing to 
its rapid absorption and extreme toxicity it is not 
well suited for the purpose, though it is occasion- 
ally employed to depress the sensory endings when 
d^'spepsia is attended with pain in the stomach. 
Death occurs so quickly from fatal doses, owing to 
the rapidity of al)Sorption from the mouth and 
stomach, that there is rarely a chance for medical 
interference. It causes paralysis of the heart and 
respiration; hence artificial respiration is of no 
avail in the majority of cases, but if the dose has 
been insufficient to paralyze the heart strychnin 
may be used as a respiratory stimuhmt. Sodium 
hyposulphite is said to be useful as a cliemic anti- 
dote, since it forms the sulphocyanid. From 2 to 
4 drams (S to IG grams) of the hyposulphite dis- 
solved in water is directed to be injected sulicu- 
taneously. 

ACIDUM HYDltOCVAXlcr.M DlLlTUM. 1". S. P. 

— Diluted Hydrocyanic Acid contains 2 ])er cent, 
of absolute hydrocyanic acid. As found in the 
shops it is of variable strength, owing to its ten- 
dency to decompose. 

Dilute hydrocyanic acid is sometimes used on 
tbo unbroken skin to allay itching, and it iiiny lie 
used internally with extreme eaiition to prevent 
the vomiting of pregnancy. 



244 PHARMACOPEIA AND PHYSICIAN. 

THE ATROPIN GROUr. 

Atropin, which will be mentioned among the 
tinalgesics, acts locally as an anesthetic, its effects 
resembling those of cocain, but being weaker. 

Atropina.^U. S. p. — Atropin is officially de- 
scribed as an alkaloid obtained from Atropa Bel- 
ladonna and from other plants of the same fam- 
ih^ As it occurs in commerce, it is usually con- 
taminated l)y a small amount of hyoscyamin, from 
which it can not be readily separated. 

Atropin is soluble in 450 parts of water and in 
1.5 parts of alcohol. It is very poisonous, the 
average dose being 0.0004 gm. (1/160 grain), and 
it should, therefore, be tasted with the utmost cau- 
tion and only in dilute solution. 

Atropin.e Sulphas. — U. S. P. — This is the 
sulphate of the alkaloid atropin. In its physiologic 
properties and dose, atropin sulphate corresponds 
closely fo atropin. It is soluble in less than one 
part of water and in about four parts of alcohol. 

Oleatum ATROPiN.^i:. — U. S. P. — Oleate of 
Atropin is a mixture of equal parts of oleic acid 
and olive oil, containing 2 per cent, of atropin, in 
solution. 

EXTRACTUM BELLADONX^Ti: FOLIORUM. U. S. 

p. — Extract of Belladonna Leaves is directed to be 
made with a menstruum consisting of two parts of 
alcohol and one part of water, and should contain, 
when assayed according to the process given in 
the Pharmacopeia, 1.4 per cent, of mydriatic al- 
kaloids. 

Unguentum Belladonna. — U. S. P. — Bella- 
donna Ointment contains 10 per cent, of extract of 



LOCAL AXESTHETICS. 245 

belladonna leaves in a mixture of liydrous wool fat 
and benzoinated lard. 

E:MPLASTEUii BELLADOXNiE. — U. S. P. — Bella- 
donna Plaster is now directed to be made by mix- 
ing 30 parts of extract of belladonna leaves with 
70 parts of adhesive plaster, and corresponds close- 
ly with the widely used, commercial, rubber-base 
plasters. It is further directed that spread bella- 
donna plasters should yield, when assayed by the 
process given in tlie Pharmacopeia, not less than 
0.38 nor more than 0.42 per cent, of mydriatic 
alkaloids. 

Fluidextractuji Belladoxx.e Eadicis. — U. 
S. P. — Fluidextract of Belladonna Boot is directed 
to be made with a mixture containing four parts 
of alcohol and one part of water, and should yield, 
when assayed by the process given in the Phar- 
macopeia.. 0.5 per cent, of mydriatic alkaloids from 
belladonna root. 

LixiMEXTU.M Belladoxn^^ — U. S. P. — Bella- 
donna Liniment is virtually a solution of five parts 
of camphor in a sufficient quantity of fluidextract 
of belladonna to make 100 parts. 

Fluidextkactum Stramoxii. — U. S. P. — This 
i.s directed to be made from the leaves of Datura 
Stramonium with a menstruum containing two 
parts of alcohol and one part of water. The fin- 
i<lied fluidextract is required to contain 0.35 per 
cent, of the mydriatic alkaloids from stramonium. 

ExTRACTUM Stramoxii. — U. S. P. — Extract of 
Stramonium is made by evaporating the fluidex- 
tract to the required consistency, ami should con- 
lain 14 p'er cent, of mydriatic alkaloids. 



246 PHARMACOPEIA AND PHYSICIAN. 

Unguentum Stramonii. — U. S. P. — Stramo- 
nium Ointment contains 10 per cent, of extract of 
stramonium in a mixture of hydrons wool fat and 
benzoinated lard. 

Atropin, in this form of an ointment or the 
oleate, and the extracts of belladonna and of 
stramonium, in the form of ointments, belladonna 
plaster and belladonna liniment are very common- 
ly employed as local applications for the relief of 
the various neuralgias. The members of the atro- 
pin group are said to be more efficacious in facial 
than in other neuralgias, but they are also used 
for the intercostal variety and for lumbago. 

Atropin is sometimes employed locally to pre- 
vent sweating, but it is of doubtful value for this 
purpose. 

Belladonna plasters are very commonly used, 
particularly by the laity, for a variety of pains, 
often serving merely to protect the surface, or for 
the retention of body heat. They slowly induce a 
diminished sensitiveness in the surface to which 
they are applied, and occasionally they give rise to 
toxic symptoms. 

Suppositories of extract of belladonna are fre- 
quently used with benefit in the treatment of 
hemorrhoids. 

They may be directed somewhat as follows : 

I^. Extracti belladonnse fol or. i jOG 

Olei theobromatis 3ii sj 

M. Ft. suppositoria No. viii. 

Sig. : One every four hours, as directed. 

Belladonna ointment may be used for the same 
purpose. It may be directed to be spread on a 
little cotton which is placed in contact with the 
piles and they are then replaced in the rectum. If 



LOCAL AXESTHETICS. 247 

the}' still tend to protrude a pad of cotton is placed 
over the anus and held in position b}- a bandage. 
For men the bandage may be attached' to the sus- 
penders, both back and front, when the severit}^ 
of the attack is not such as to compel the patients 
to lie down. 

It must be remembered that the extract of bel- 
ladonna, whether applied as a suppository or oint- 
ment, is rapidly absorbed and the amount so used 
must not exceed the therapeutic dose. 

ACONITE. 

Aconite owes its action almost entirely to aconi- 
tin, an alkaloid which, like cocain, is composed of 
a base united to an aromatic acid. Closely re- 
sembling aconitiu in its local action is veratrin. 
They both cause irritation when applied to the 
mucous membrane. 

The effect of aconitin when taken by the mouth 
is very characteristic, the local effect being a tin- 
gling and then a disagreeable sensation in the 
throat which has been variously termed itching or 
"scratching." Applied to the skin, aconitin causes 
sensory stimulation, Avhich is succeeded by local 
anesthesia without the production of rubefaction. 

Aconitin is much less efficacious than cocain as 
a local anesthetic, and, of course, its injection is 
wholly inadmissible, but it is much more useful in 
the form of a liniment which is to be applied to 
the unbroken skin, through which aconitin may 
jienetrate to a slight extent. 

AcoNiTiNA.— U. S. P.— An alkaloid ohtained 
from the official aconite, the tuberous root of 
. 1 conUum najjellus. There are a number of close- 



248 PHARMACOPEIA AND PHYSICIAN. 

ly related species of aconite that contain alkaloids 
which differ widely in their physiologic action and 
dose. The now official aconitin is the purified 
crystalline alkaloid of the official root and should 
not be confounded with the amorphous alkaloid 
formerly official or with any one of the more potent 
alkaloids obtained from other species of aconite. 

Aconitin is soluble in 3^200 parts of water and 
in 23 parts of alcohol. On account of the poison- 
ous character of this alkaloid, it should never be 
tasted, except when in very dilute solution. 

Average dose: 0.00015 gm. (0.15 nig. or 1/400 
grain). 

Fluidextractum Aconiti. — U. S. P. — Fluid- 
extract of Aconite is directed to be made from the 
powdered root of Aconitum napellus with a men- 
struum composed of three parts of alcohol and one 
part of water. It should contain no less than 0.4 
per cent, of aconitin. 

TiNCTUEA AcoNiTi. — U. S. P. — This tincture 
now represents 10 parts of the crude drug, instead 
of 35 parts, as formerly official. It is made with a 
menstruum containing 7 parts of alcohol and 3 
parts of water, and the finished tincture should 
contain 0.045 per cent, of aconitin. 

VEEATRIN. 

Somewhat closely related to aconitin, in its vari- 
ous properties and uses, is veratrin, which is offi- 
cial in several well-known forms. 

A^EKATRiXA. — U. S. P. — The official Veratrin is 
a mixture of alkaloids obtained from the seeds of 
Asagrcea officinalis. It occurs as a white or a 
grayish-white amorphous powder that is soluble in 



LOCAL ANESTHETICS. 249 

about 1.750 ^^^I'ts of water and in 2.3 parts of 
alcohol. 

OLEATUii Yeratkin^i:. — U. S. P. — Oleate of 
Veratrin contains 2 -per cent, of veratrin in a mix- 
ture of equal parts of oleic acid and olive oil. 

UxGUENTUii Yegatein^-32. — U. S. P. — Veratrin 
Ointment contains 4 parts of veratrin with 6 parts 
of expressed oil of almonds and 90 parts of ben- 
zoinated lard. 

LOCAL uses of ACONITIX. 

Aconitin is sometimes used locally in the form 
of an ointment (from 1 to 100 to 1 to 500) ;, or in 
the form of an oleate. made similarly to the offi- 
cial oleates of atropin or of veratrin^, of 2 per cent, 
strength, for the relief of rheumatism and neu- 
ralgia. Inasmuch as it is absorbed in these forms 
from the unbroken skin, and much more rapidly 
from wounds or mucous membranes, it must be 
used with caution. 

For facial ncui'aliria it may ho proscribed as 
follows : 

IJ. Aconitini gr. iii 120 

Alcohol q. s. to dissolve | 

Adipis 3iv 1 5 1 

M. Ft. unguent'.:!!'.. 

Sig. : Apply a vory little of tho ointinont over the 
seat of the pain. 

The fliiidextract of aconite may be further con- 
centrated and used in the form of an ointnionl. or 
it or the tincture of aconite may be used a.^ a liiii- 
niont, applied on cloth, and a hot jiail oi' walcr hoi- 
llo laid over the surface. 

For muscular rheumatism a liniment composed 
of equal parts of the tincturo, or a con'esponding 



250 PHARMACOPEIA AND PHY8ICIAN. 

amount of the fluidextract and soap liniment ma}^ 
be rubbed on the surface, or, if desired, this lini- 
ment may be further varied by the addition of 
chloroform liniment, or other alcohol soluble 
rubefacient in place of- the soap liniment. 

The following is the formula recommended by 
Magitot for toothache: 

R. Tineturae aconiti 

Chloroformi, aa m. xlv 3 

Tineturae benzoini m. cl 10 

M. Sig. : Apply as needed. 

PHENOL. 

Phenol, or carbolic acid, has been considered 
under the subject of antiseptics. 

Applied to the skin, pure or in concentrated so- 
lution, it causes tingling and some pain, with the 
formation of a white eschar and a rapidly induced 
partial or complete anesthesia of the part. It is so 
prone to absorption when weak solutions are used 
that its usefulness is interfered with to a great 
extent. 

Phenol, in 2 to 3 per cent, solution, applied for 
a short time only, causes wrinkling, with a lessen- 
ing of sensibility and of the secretion of sweat, 
but solutions even as weak as 3 per cent., applied 
for some hours to an extremity, for instance to the 
finger, may give rise to gangrene resembling that 
seen in ergotism. Kobert states that this has been 
reported in no less than 50 cases in the past few 
years. 

Phexol. — U. S. P. — The Acidum Carbolicum 
of former pharmacopeias, occurs as sejDarate 
needle-shaped crystals or as a white crystalline 
mass that is soluble in about 20 parts of water, but 



LOCAL AXESTHETICS. 251 

is freely so]iil)]e in aleohol, glycerin or in fixed or 
volatile oils. Phenol will absorb or dissolve from 
15 to 20 per cent, of water, and then occurs as a 
colorless or slightly reddish liquid. 

If a solution of phenol stronger than 5 per cent. 
is desired, the phenol should be added to an equal 
volume of glycerin and the mixture diluted to the 
required degree. Failure to observe this precau- 
tion has resulted seriously, owing to the separation 
of phenol from the solution. 

Phenol Liquefactum. — U. S. P. — Liquefied 
Phenol should contain not less than 86.5 per cent. 
by weight of absolute plienol and about 13.G per 
cent. l)y weight of water. 

Glyceritum Phenolis. — U. S. P. — Glycerite 
of Phenol consists of 20 parts of liquefied phenol 
and 80 parts of glycerin, by measure. 

UxGUEXTUM Phenolis. — U. S. P. — Ointment 
of Phenol is now directed to contain 3 per cent, of 
jjlionol, in white petrolatum. 

Phenol is occasionally used for the production 
of anesthesia preliminary to incising the skin, and, 
in the form of the glycerite, oi' |)referably the oint- 
ment, it is very useful in allaying the pain of 
small ulcers and burns.. It may momentarily in- 
crease the pain, but this is soon followed by less- 
ened sensibility. 

It is, of course, obvif)Us that the use of ])h('n()l 
is not pennissiMc where lai-ge surfaces are to l)e 
treated. 

When antisepsis is not of especial importance 
the ointment is to be preferred, as the continuous 
application of even comparatively weak aqueous 
.solutions to the extremities has caused gangrene. 



CHAPTER XI. 

GENERAL ANESTHETICS. 

The subject of general anesthesia concerns the 
surgeon much more than it does the physician, but, 
as in the matter of antisepsis, the physician must 
have some knowledge of this subject, and we shall, 
therefore, briefly consider the more important 
members of the group of general anesthetics, their 
uses and their probable limitations. 

Narcotics have been used from time imme- 
morial, for producing unconsciousness during sur- 
gical operations, but nitrous oxid has been in use 
longet than any other agent now employed for in- 
ducing general anesthesia. It is more than 100 
years since Sir Humphrey Davy first suggested this 
use for nitrous oxid after observing its effects on 
himself while he was suffering with toothache, but 
his suggestions met with no response, and it was 
not until many 3'ears later, in 1844, that Horace 
Wells, a dentist of Hartford, Conn., employed it 
for that purpose and thus introduced what he was 
pleased to term "a new era in tooth-pulling." 

It was at one time supposed that nitrous oxid 
caused unconsciousness merely through asphyxia, 
and, while this is a very important factor, it has 
been shown that nitrous oxid also causes a depres- 
sion of the central nervous system resembling that 
of the methane derivatives, such as chloroform and 
ether, and complete anesthesia has been produced 
without asphyxia by using a mixture of oxygen 



GENERAL ANEf^THETICS. 253 

and nitrons oxicl nnder pressure. This would 
probably constitute an ideal method of inducing 
anesthesia were it not for the mechanical difficul- 
ties and the expense that it necessarily involves. 

Xitrous oxid is usually administered only for a 
short time, it being necessary to discontinue it so 
soon as marked cyanosis of the face occurs, after 
which the anesthesia lasts for about a minute or 
two. It is the safest agent which we possess for 
general anesthesia, the death rate being approxi- 
mately one in half a million cases, but, aside from 
its use in dentistry and for inducing unconscious- 
ness preliminary to other anestlietics, its applica- 
tion is extremely limited. 

In the larger hospitals of ISTew York, ether anes- 
thesia is now systematically preceded by nitrous 
oxid or ethyl chlorid. 

It is impossible to estimate the value to man- 
kiml. and to surgery in particular, of the introduc- 
tion of anesthetization with ether by Morton and 
Jackson some fifty years ago. Its use Ijy Dr. Craw- 
ford W. Long, in Cleorgia, antedates l)y more tlian 
two years the real work of Morton and Jackson in 
introducing the method, l)ut the greatest credit is 
due those men for tlieir splendid achievement in 
gaining general recognition for this boon to hu- 
manity. 

Shortly after the iiitrodiietioii of goneial anes- 
thesia by the use of rllicr Sii' ,1. Y. Simpson an- 
nounced liis discovery of the use of chloroform 
as an anesthetic, and this latter agent soon dis- 
])laced ether almost entirely in many parts of the 
world. Even at present chloroform is used almo.-^t 
exclusively in several European counti'ies. 



254 PHARMACOPEIA AXD PEYSICIAN. 

From time to time otlier agents have been pro- 
posed as substitutes for chloroform and ether, and 
some of them have enjo3-ed a greater or less popu- 
larity for a time, only to sink into obscurity. 

In this connection we may mention a few of 
those which will be remembered even by the 
younger generation of physicians, and which have 
not yet fallen into complete disuse. 

Ethyl bromid and bromoform have been used 
to some extent as general anesthetics, and it has 
been suggested that the typical bromid action 
might be obtained from them, but the action is 
that of the entire molecule. Both of these have 
passed almost completely from use as general an- 
esthetics, largely, perhaps, because of the unstable 
character of the substances themselves and the ac- 
companying uncertainty of the action of the de- 
composition products. 

Petroleum ether, or benzin, because of its 
cheapness, is sometimes used in vivisection experi- 
ments, but not on man. 

The use of mixtures of varying composition ap- 
pears to oifer a peculiarly interesting field for ex- 
perimentation in connection with general anesthe- 
sia. 

Of the several mixtures that have been used 
from time to time, that popularly laiown as the 
A. C. E. mixture, containing 1 part of alcohol, 2 
parts of chloroform and 3 parts of ether, is per- 
haps the one that has been used most widely. This, 
also referred to occasionally as the one-two-three 
mixture, was, at one time at least, quite popular 
in England. While it has been urged against this 
mixture that the differences in volatilitv of the 



GENERAL ANESTHETICS. 255 

three substances prevent the anesthetist knowing 
just what he is administering, it is a fact that the 
vapors of all three tend to pass off together, and, 
furthermore, the object is to induce anesthesia and 
to avoid an excess of the anesthetic and the action 
of the mixture seems to be as easil}- controlled as 
that of chloroform, while not so much is required 
as of ether alone. The alcohol and chloroform 
raise the boiling point of the mixture above the 
temperature of the lungs, and this probably secures 
some of the advantages claimed b}' Schleich for 
the mixture of ether, chloroform and benzin. 

A mixture containing 57 parts of ether and 43 
parts of chloroform has been suggested as having 
some advantages over either of its component 
parts. It was at one time quite widely recom- 
mended under the title of M. S. mixture, but ap- 
pears to have fallen into disuse, having probably 
no advantage over the better known A. C. E. mix-" 
ture mentioned above. 

Dr. Carl Ludwig Schleich of Berlin some years 
ago recommended the admixture of 5 per cent, of 
])etroleum ether, or benzin, with ether and chloro- 
form, as a general anesthetic. Tbis preparation 
liad been used by Schleich in nearly 500 cases in 
which he obtained excellent results, such as ab- 
sence of excitement and of the excessive salivary 
discharge so frequently seen with ether, while the 
depressing effect of the chloroform on the heart was 
not observed. Despite these and other advantages, 
which he cited at the time, the mixture never at- 
tained much popularity, and even Schleich himself 
appears to have discontinued ils use in favor of 
an ethyl chlorid mixture. 



256 PHARMACOPEIA AND PHYSICIAN. 

The mixture of ether, chloroform and ethyl 
chloric! has been proposed at different times and in 
varying proportions; the one proposed by Schleich 
contains 2 parts of ethyl chlorid, 4 parts of chloro- 
form and 12 parts of ether, and is fairly repre- 
sentative of this class. 

The advisability of using mixtures of any kind, 
for general anesthesia, is still an open question, 
particularly in view of the fact that the several 
chemical substances themselves are far from being 
absolutely stable, even under the most favorable 
conditions, chloroform particularly being readily 
decomposed and forming, as one of the possible 
decomposition products, the really dangerous sub- 
stance known as phosgene. 

MAGNESIUM SULPHATE. 

S. J. Meltzer has recently suggested the use of 
a solution of magnesium sulphate for inducing 
general anesthesia. For this purpose he advised 
the intraspinal injection of 1 c.c. (15 minims) of 
a 25 per cent, sterilized solution of magnesium 
sulphate for each 25 pounds of body weight. This 
method possesses no advantage over cocain used in 
the same way for producing anesthesia of the lower 
parts of the body, but general anesthesia is induced 
and persists for some hours, and the method, there- 
fore, may possibly prove serviceable in controlling 
the convulsions of tetanus. 

Marked depression of the respiration occurs, 
and it must be used only with extreme caution. 
The sudden introduction of a small quantity of 
this solution into the blood vessels will imme- 
diately prove fatal. 



GENERAL ANESTHETICS. 257 

scopoLA:nix-:\iORPHi>r axd similar solutions. 

The constant search for less dangerous anesthet- 
ics than ether and chloroform brings many sub- 
stances into notice. Morphin and scopolamin have 
found an ardent champion in Korff, who has 
used them for several years. He employs up to 
0.035 gm. (1/2 grain) of morphin and 0.0013 gm. 
(1/45 grain) of scopolamin. Unconsciousness 
does not occur, and he claims absolute quiet must 
be maintained, while he stops operating long 
enough for pain to subside. He advises "drops" of 
chloroform or ether when necessary. The tongue 
must not be permitted to fall back into the throat. 
The use of this method of ' anesthesia in major 
surgery must obviously be very limited. A discus- 
sion of a nu7nber of fatalities attending the use of 
morpliin and scopolamin for general anesthesia 
will be found in La Semaine Medicale, Nov. 8, 
1905, p. 529, and in The Journal of the Ameri- 
can Medical Association during 1906 and 1907. 

The combination of scopolamin and morphin 
may have certain advantages in obstetrics, but it is 
of the utmost importance that the proper technic 
be observed. Gauss has elaborated a method most 
carefully, and those who employ the combination 
will do well to read his article in the Centralblatt 
fi'ir Gyn., Jan. 12, 1907. Other authorities con- 
demn the practice on the grounds that it is liarm- 
ful to mother and cliild without accomplisliing tlie 
desired results. 

In view of tlio loiowii (hiiiu'crs altiMiding tlic use 
of scopolamin and morijhiii \\r must view the 
statements of those wlio are fiiiaiicinlly interested 
in the sale of this combination with extreme sus- 



258 PHARMACOPEIA AND PHYSICIAN. 

picion. It can not be stated too emphatically that 
cactin adds nothing whatsoever to the safety of 
this combination. 

Morphin sulphate alone or in combination with 
atropin sulphate is very commonly employed pre- 
liminary to chloroform or ether narcosis, and ap- 
pears to have well-established uses in this connec- 
tion. 

E. Fraenkel reported some ten years ago that 
he had habitually used a mixture of morphin, 
atropin and chloral for hypodermic injections, pre- 
liminary to narcosis, for twenty-two years, without 
an accident. He claimed that this procedure less- 
ened to an extraordinary degree the amount of 
chloroform or ether used to maintain anesthesia. 

The solution used by Fraenkel was made as fol- 
lows : 



Morphin muriate gr. iiss 

Atropin sulphate gr. i^ 

Hydrated chloral gr. iv 

Distilled water 5ss 15 



15 

015 

25 



He injected hypodermically from 1 c.c. to 1.25 
c.c. (15 to 19 minims) fifteen minutes before the 
commencement of the ether or chloroform admin- 
istration. 

Fraenkel further asserts that this mixture is 
free from the objectionable side actions of mor- 
phin, being well borne by patients who could not 
take morphin by the mouth or hypodermically. 

ETHYL CHLORID. 

A substance which bids fair to rival chloroform 
and ether as a general anesthetic, under certain 
conditions at least, is ethyl chlorid. 



GENERAL ANESTHETICS. 259 

This substance is extremely volatile, boiling at 
from 12° to 13° C. (53.6° to 55.4° F.), and it 
is necessary, therefore, to keep it in sealed tubes. 
The ends of the tubes are drawn out to fine capil- 
lary tubes which are then sealed, or the capillary 
opening is closed by a metal cap which may be re- 
placed when a part of the contents of the tube has 
been used. When required for use the glass tip 
is broken off, or the metal cap unscrewed, when the 
heat of the hand causes the ethyl chlorid to vola- 
tilize, forcing out a fine stream which may be di- 
rected against the surface which is to be frozen for 
local anesthesia, or the stream may supply the 
vapor for inhalation to produce general anesthesia. 

Ethyl chlorid induces anesthesia more rapidly 
than ether docs, and when it is withdrawn the pa- 
tient recovers more quickly, thus saving an average 
of some twelve minutes on each operation, hence it 
is likely to prove useful on the battlefield and in 
great calamities when a number of operations must 
be performed with a minimum loss of time. 

Figures purporting to give relative degrees of 
danger for various anesthetics are notoriously un- 
reliable, but it seems probable that ethyl chlorid is 
less dangerous than chloroform and somewhat 
more dangerous than ether. Among the objec- 
tionable features of ethyl chlorid are increased 
cost, the explosive character of the vapor, extreme 
volatility, tlie accompanying waste of material and 
the difficulty of maintaining anesthesia. 

A numlxT of masks have been devised for use 
with etbyl chlorid. It has been suggested that the 
mask should be so arranged that the anesthetic 
docs not come too near the face, as freezing may 



2G0 PHARMACOPEIA AND PHY^SIGIAN. 

thus ensue. Ethyl chloric! appears to be especially 
adapted for short operations, and in some hos- 
pitals it is replacing nitrous oxid preliminary to 
ether anesthesia. 

ACTION or CHLOROFORM AND ETHER. 

It would hardly be profitable to discuss here in 
detail the actions of chloroform and ether, but 
there are certain important points concerning them 
which are so frequently overlooked that we will 
consider them briefly. 

While there are records of as many as 40,000 
consecutive anesthetizations with chloroform with- 
out a fatality, this is only possible in case of skilled 
anesthetists working with carefully selected cases. 
Certainly no such results are possible in ordinary 
practice, and with that alone we are concerned at 
present. 

We must always remember that the production 
of general anesthesia is a grave matter, in which 
death is an ever-present possibility despite the ut- 
most care, and of which there is actual danger un- 
less' caution is observed. The possibility of fatal 
complications in all cases of general anesthesia 
would appear to make it necessary that the patient 
or his friends be informed of this fact, if for no 
other reason than to- protect the physician admin- 
istering the anesthetic. 

Each case must be carefully considered when se- 
lecting the anesthetic, and neither chloroform nor 
ether should be used exclusively. Ether being the 
safer, however, should have the preference, when 
it is not contraindicted, and chloroform should 
not be used unless the anesthetist is experienced 
and is reasonably skilled in the use of it. 



GENERAL ANESTHETICS. 261 

The following are some of the princijjal advan- 
tages and contraindications of both of these agents : 

The vapor of ether is inflammable, that of chlo- 
roform is not, and the latter is to be preferred when 
operations are to be performed bj' gas or lamp- 
light. In this connection, however, we must not 
forget that chloroform vapor coming in contact 
with an open flame is readily decomposed into 
chlorin and hydrochloric acid, and that it will be 
necessary, therefore, to provide for free ventila- 
tion to eliminate these decomposition products. If 
ether must be used under such circumstances, the 
light should be placed as high above the level of the 
mask as practicable, since ether vapor is heavier 
than air. The thermocautery can, of course, also 
ignite the vapor of ether. 

An acute cold is a contraindication to the use of 
any anesthetic, but more particularly to the use of 
ether. Ether is also contraindicted in bronchitis, 
because of the great irritation caused by the rela- 
tively large amount necessary to maintain anes- 
thesia; it is likewise contraindicated in nephritis, 
since the kidneys take part in the excretion, and 
suffer from the irritant action. 

In extremely hot weather, that is, when the ther- 
mometer is above 93° to 95° F. (34° to 35° C), 
ether is volatilized so rapidly that the atmosphere 
contains amounts which may prove objectionable, 
and it often becomes very difficult to maintain 
complete anesthesia. 

When it is absolutely imperative to reduce tlie 
stage of excitement to the minimum, or when it 
becomes necessary to secure complete anesthesia 
rapidly, ether is contraindicated and chloroform is 



262 PHARMACOPEIA AXD PHYSICIAN. 

to be preferred when it is not specifically contra- 
indicated for other and more important reasons. 
In the latter event eth}-! chlorid may be used, or 
preliminary imconscionsness may be induced by 
nitrous oxid. and this followed up by the use of 
ether. 

Chloroform is very commonly preferred by ob- 
stetricians, but deep anesthesia is not usually in- 
duced in such cases. 

In fatty disease of the heart chloroform is con- 
traindicated because it also induces fatty degenera- 
tion of that organ, and for this reason it is not ad- 
visable to use it repeatedly on the same person in 
succeeding operations. 

Chloroform is much more toxic to the heart than 
ether, and there is a much narrower margin for 
safety between the amount necessary to induce an- 
esthesia and that which causes death, chloroform 
being much more active than ether in inducing 
anesthesia, but very much more toxic. 

A matter of the greatest importance, especially 
for the unskilled anesthetist, is the very brief in- 
terval between the cessation of respiration and the 
stopping of the heart beat with chloroform, giving 
very little chance to resuscitate the patient after 
respiration has stopped. With ether the interval 
is much longer, and the prompt resort to artificial 
respiration, while the body is raised higher than 
the head, very commonly results in saving the pa- 
tient. 

This difference in the action of anesthetics and 
also the fact that the condition of anesthesia is a 
dangerous one, according to the degree to which it 
is carried, will be more fully appreciated if we 



GENERAL ANESTHETICS. 263 

have a clear conception of the several stages of an- 
esthesia and the rapidity with which a patient may 
pass from one stage into the other. 

These several stages are usually designated as : 
1, the stage of excitement; 2, the narcotic and 
anodyne stage; 3. complete anesthesia; 4, paraly- 
sis and death. 

The acceleration of the circulation noticed in the 
first stage is similar to that produced by the inges- 
tion of alcohol or alcoholic beverages^ and the pro- 
duction of this stage was one of the uses to which 
ether was put long before it was used as an anes- 
thetic in surgical operations. From this stage the 
patient usually passes quite gradually into the 
second or narcotic stage. 

In the narcotic stage sensibility becomes im- 
paired, but there is not infrequently a persistence 
of reflex action which manifests itself in a form of 
delirium or wild excitement. This is usually an 
indication of faulty anesthetization and is a com- 
plication that can be avoided in many instances by 
the more careful preparation of the patient for the 
anesthetic. In the majority of instances, however, 
the patient passes rapidly into the third stage, 
that of complete anesthesia. In this stage there 
is complete absence of reflex action, even of 
the conjunctiva, which is usually, though erron- 
eousl}', advocated as the most satisfactory test for 
complete anesthesia. A satisfactory surgical anes- 
thesia is indicated by complete relaxation of nearly 
all of the muscles of the body, regular breathing, 
ilcep inspirations ami a fully relaxed lower jaw. 
Tiie widely prevailing though barbarous habit of 



264 PHARMACOPEIA AND PHYSICIAN. 

touching the conjunctiva should never be re- 
sorted to. 

By the careful administration of the anesthetic 
this stage of surgical anesthesia may be continued 
for a considerable period of time, but we must 
never forget that it is ever bordering on, and may 
at any moment pass into, the fourth or paralytic 
stage, when respiration ceases, the heart beats be- 
come feebler, and, unless vigorous and prompt 
restorative measures can be resorted to, may cease 
entirely. 

THE ADMINISTRATION OF ETHER. 

While it has been asserted that the administra- 
tion of anesthetics is an art that can not be taught 
or learned, but must be acquired, it is also true 
that there are certain points or rules that have been 
sufficiently well established to warrant their being 
heeded, and the general conduct of anesthetization 
can best be illustrated, perhaps, by giving the 
method pursued by an ordinarily careful anes- 
thetist, when nitrous oxid is not used. 

The patient, who should not have had food for 
five hours preceding, is made thoroughly comfort- 
able, in a recumbent position, on a table or wheel 
stretcher, if in a hospital, with a pillow just suffi- 
cient to raise his head but slightly. 

The mouth is freed from false teeth and other 
foreign materials, and the lips and nose are an- 
ointed with petrolatum to avoid the accompanying 
irritation from contact with the anesthetic. 

A pad of moistened gauze is then placed over the 
eyes to avoid irritation by the fumes of the anes- 
thetic. 



GENERAL ANESTHETICS. 265 

All these several stages should be carefully ex- 
plained to the patient so as to assure him that 
every possible precaution is being taken to provide 
for his comfort and well-being, and to gain his 
confidence, for the more important feature of ad- 
ministering the anesthetic itself. 

After the patient has been prepared and his con- 
fidence gained by explanation of the several stages 
of the preparation, he is allowed to accustom him- 
self somewhat gradually to the taste and smell of 
ether. To accomplish this the cone or gauze con- 
taining the anesthetic is held some slight distance 
from his face, and gradually brought closer as the 
patient becomes more and more accustomed to the 
inhalation. If the anesthetist has been successful 
in gaining the confidence of the patient he will 
find that the latter will pass through the prelim- 
inary stages of anesthesia without a struggle, and 
that complete relaxation will l)o secured witli a 
minimum of the anesthetic. 

When a patient has been completely anesthetized 
less of the anesthetic will suffice to nuiintain the 
condition and the further efforts of the anesthetist 
can be devoted to observing the respiration and 
the surface reflexes of the patient in order to pro- 
vent his reverting to the second stage of anes- 
thesia, or passing on into the much-to-l)c-(lrca(]o(l 
stage of paralysis of the respiratory center. 

With chloroform the passing from one stage of,, 
aiu'stbesia to the next is mucli moi'c rapid tlian 
witb ether, less of the anesthetic is used, more aii- 
must be allowed, and there is. of coui'so, a cor- 
respondingly siiiallfT iiiai'gln of safely in the stage 
of complete surgical anesthesia. 



2GG PHARMACOPEIA AND PHYmCIAV. 

Since all of us can not become expert anesthet- 
ists and yet must at times perform that office, this 
advantage of ether is well worth consideration. 

The greatest immediate danger from inhalation 
of ether or chloroform, but more especially of the 
latter, is the administration of the vapor in too 
great concentration. One hundred volumes of air 
require approximately from three to four volumes 
of ether vapor, and 100 volumes of air require 
about one volume of the vapor of chloroform to in- 
duce anesthesia, but an increase of from two to 
three volumes in the concentration of the ether, 
or of only one volume of chloroform in 200 of air 
will prove fatal in a short time. 

While we do not actually measure the relative 
volumes of air and vapor, as a rule, these figures 
will serve to show the comparative danger of the 
two substances, for it is many times more difficult 
to avoid overstepping narrow boundaries than 
broad ones. 

When a perfectly safe ratio is maintained the 
delay in inducing anesthesia often proves vexa- 
tious, and the anesthetist may be urged to expedite 
the operation by increasing the concentration, but 
he should never forget the grave responsibility 
which he has assumed and should never permit the 
impatience of others to induce him to exceed the 
limits of caution, save only in those grave emer- 
gencies where delay in operating may mean death 
to others who are awaiting their turn. 

OFFICIAL ANESTHETICS. 

tEthylis Chloridum. — U. S. P. — Ethyl 
chlorid occurs as a colorless, transparent, very vol- 



flEXERAL AXESTHETICS. 267 

atile liquid, having a characteristic, rather agree- 
able odor and a burning taste. It is only slightly 
soluble in water, but is readily miscjble with alco- 
hol. 

Ethyl chlorid is a haloid derivative, and is pre- 
pared by the action of hydrochloric acid gas on ab- 
solute ethyl alcohol. It is usually marketed in 
hermetically sealed glass tubes, and when liberated 
at ordinary room temperature volatilizes almost in- 
stantly. The resulting gas is very inflammable 
and the substance itself should never be used in 
])roximity to an open flame or fire. 

For local anesthesia the liquid in a fine spray 
is applied to the surface to be anesthetized. 

The average amount necessary to induce general 
anesthesia is from 5 to 10 c.c. (75 to 150 minims). 

iETHER. — U. S. P. — Ether is a transparent, 
colorless, volatile liquid having a characteristic 
odor and a pungent, sweetish taste. It should con- 
tain 96 per cent, by weight of absolute ether or 
ethyl oxid and about 4 per cent, of alcohol contain- 
ing a little water. 

The per cent, content of ethyl oxid or absolute 
ether in a given specimen is a matter of consider- 
able importiince when the substance is to be used 
for anesthesia. The official other, when exposed 
to air, absorbs moisture, thus materially re- 
ducing the anesthetic value of the ether. The 
practice that has long been followed of sending 
out ether in hermetically sealed cans is an efficient 
safeguard against this absorption of moisture. 

CiiLOHOFOijMUM. — U. S. P. — Chloroform is a 
heavy, clear, colorless liquid having a characteristic 
ethereal odor and a burning, sweet taste. It should 



268 PHARMACOPEIA AND PHYSICIAN. 

contain not less than 99 per cent, by weight of ab- 
solute chloroform and from 0.6 to 1 per cent, by 
weight of alcohol. 

Chloroform when not pnre is readily decom- 
posed, forming chlorin compounds that may prove 
to be extremely dangerous to the patient. Even 
chloroform that corresponds to the requirements 
of the Pharmacopeia may be decomposed in the 
presence of damp air and heat, and the substance 
should, therefore, be carefully preserved in small, 
well-stoppered bottles. 



CHAPTER XII 



EXPECTOEAXTS. 



The expectorants official in the United States 
Pliarmacopeia afford a great variety of choice. In- 
numerable combinations are possible, but we shall 
suggest only a few of these, in connection with 
some of the drugs and preparations available. 

It should be remembered that coughing serves to 
remove mucus from the respirator}^ tract and often 
requires no treatment. If, however, the cough 
becomes unduly severe, it may require alleviation; 
if the secretion is scanty it may he increased or 
rendered more liquid. 

Acute bronchitis may be divided into two gen- 
eral stages, with certain expectorants useful in 
each stage, but this is not to l)e taken as a rigid 
classification. 

The first stage — that of dryness of the mucous 
membrane, with considerable cough — calls for sed- 
atives; the second — that of free secretion — may 
require stimulant expectorants.^ 

The prevalence of coughs and "colds'" in the 
winter montlus is sufficient evidence of tlic iiii])<)i'- 
tancc of this class of ageuls. Tlicir use in donics- 
tic practice — largely as "•patciil incdicincs,"' so- 
called — ])robabIy exceeds llial (lircclcd hy tbe 
pliysieian as ten to one. 

1. The terms "stlniiilfttlnfj" nnd "sedative" used In con- 
ned Um with expectoinnts refer only to the effect on the 
centrTM. 



270 PHARMACOPEIA AND PHYSICIAN. 

Physicians are supplied liberally with literature 
by manufacturers of proprietary remedies of this 
type, but the pharmacology of this literature is not 
always worthy of the faith that some physicians 
place in it. As an example we quote from a circu- 
lar distributed exclusively to physicians: "In se- 
vere and frequent cough, when little mucus is se- 
creted, as shown by the scanty viscal sputum, mor- 
pliin, or, better, its derivative, ethtjl-morpliin, is 
indicated, which increases secretion and lowers 
excitability of the respiratory center." For com- 
parison with this interested statement by the man- 
ufacturers we quote (merely for the sake of com- 
parison) from an article on opium in Wood's 
Therapeutics (11th ed., 716) : "Its tendency to 
check secretion forbids its use, however, in a very 
large proportion of cases, notably in those in which 
there is persistent dryness of the bronchial mucous 
membrane." Sollmann, Cushny and others state 
that morphin possesses the same property, though 
to a lesser degree than opium, which is very gener- 
ally recognized. 

The manufacturer of each cough mixture advo- 
cates the use of his particular remedy for all 
coughs, but we may be pardoned if we again quote 
Wood for comparison : "It is plain that the medi- 
cal practitioner must study in each individual case 
the relations between the cough and the amount of 
work required." 

The discovery of a medicinal agent is the signal 
for a host of imitators whose product may differ, 
if at all, merely in the substitution of an ethyl for 
a methyl grouj), or of one harmless acid radical for 
another. These are presented in increasing num- 



EXPECTORANTS. 271 

bers to the physician, who can by no possibility 
remember them all. Or, some well-known drug, 
whose length of service, if not merit, entitles it to 
some respect, is seized on to serve as a basis for 
fabulous claims, perhaps long since voiced, dis- 
proved and forgotten. 

There is still another interesting phase con- 
nected with these various nostrums. Many of us 
pride ourselves on the fact that we use only "eth- 
ical" preparations and also that we insist on know- 
ing just what we are prescribing or using. It must 
be rather embarrassing, therefore, to find that 
even the public is more exacting in this respect 
than we are and that the manufacturers of popular 
medicines, when they do advertise the com|3osition 
of their particular mixture, publish a full and 
complete formula and not an incomplete one such 
as we frequently find in the advertising pages of 
medical journals, or in the circulars that come to 
our desks. 

SEDATIVE EXPECTOR^VNTS. 

Among the official sedative expectorants to be 
used in the first, or dry, stage of cough, we have 
ipecac, tartar emetic, apomorphin, senega and 
other nauseants. 

Ipecac contains two alkaloids, emctin and ccplia?- 
lin, of which emetin is the more abundant and 
much the more active, and upon which the action 
of the crude drug mainly depends. 

Ipecac is extremely irritant to mucous surfaces, 
causing conjunctivitis and irritation of the nasal 
passages, with active secretion when brought into 
contact with those tissues, and nausea and vomit- 
ing when it is taken into the stomach. If a suffi- 



272 PHARMACOPEIA AND PHYSICIAN. 

cient amount of the drug escapes evacuation dur- 
ing emesis and passes into the intestine the irrita- 
tion causes increased peristalsis, diarrhea, and even 
bloody stools. 

It is generally accepted as a fact that ipecac 
causes vomiting by its direct action on the stomach, 
and not ])y acting on the center, as apomorphin 
does. 

As in the case of other nauseants, ipecac causes 
increased secretion by the salivary glands and by 
the mucous glands of the respiratory tract. This 
effect is more lasting with ipecac than with apo- 
morphin and certain other emetics; hence its 
greater value in expectorant mixtures. Further- 
more, 'it causes much less depression than tartar 
emetic, and this is a decided advantage in many 
cases. 

Emetin is not well suited for subcutaneous in- 
jection, as it is extremely irritant. 

The mode of action of ipecac in tropical dysen- 
tery is unknown. 

Tartar emetic, like ipecac, acts directly on the 
stomach to cause emesis. This conclusion is not 
materially affected by the oft-quoted fact that 
emesis may be induced in an animal by this drug 
after the stomach has been replaced by the bladder 
of a pig. 

Most of the drug is evacuated during the vomit- 
ing which it causes, but if a sufficient amount 
escapes into the intestine it gives rise to symptoms 
closely resembling those caused by 'arsenic, and it 
is stated that as small a dose as two grains has 
proved fatal. 



EXPECTORA^'TS. 273 

The nausea is accompanied by the usual effects 
on the pulse and mucous and salivar)'- secretion. 

Emesis usually follows an effective dose within 
twenty minutes, but. owing to the great depression 
which this drug produces, it is not nearly so useful 
as an emetic a? apomorphin. ipecac or one of the 
other metallic emetics, such as copper sulphate, 
but the nauseant dose is only about one-fifth that 
necessary for emesis ; hence it does not cause suffi- 
cient depression to interfere with its use in the 
case of robust patients. 

Apomorphin induces vomiting by direct action 
on the medulla, acting much more promptly and 
in smaller doses after subcutaneous injection than 
when given by the mouth. Small doses cause 
nausea, with the usual attendant symptoms, in- 
creased pulse rate and increased secretion of mu- 
cus and saliva. The nausea is usually of but brief 
duration. Init it is sometimes very persistent. 
Therapeutic doses of apomorphin have very little 
narcotic action and no perceptible effect on the 
heart. 

Ipecacuanha. — IJ. S. P. — Ipecac is the dried 
root of Cephaelis I pe.caciumha (Brotero), A. Eich- 
ard (Fam. Ruhi/jcea'). It is known commercially 
as Rio. Brazilian or Para ipecac, or the correspond- 
ing portion of C. aciimiruiUi, Ivarsten, known com- 
mercially as Carthagena ipecac, yielding, when as- 
sayed l)y the ])rocess given in the Pharmacopeia, 
not less than 2 per cent, of ipecac alkaloids. Ipe- 
cacuanha was first (lescrilx'd by Piso and ]\rarkgraf, 
in 1648, in tli<'ii- naliinil lii>lniT of I',i';i/.il. The 
drug appears to ha\c Ikmh well known to the na- 



274 PHARMACOPEIA AND PHYSICIAN. 

tives of Brazil and to have been much prized for a 
variety of therapeutic purposes. It was introduced 
into Europe, about 1675, by John Helvetius, of 
Paris. The Carthagena variety of ipecacuanha is 
a comparatively recent introduction, being first 
noted as a distinct variety, about 1870. Ipecacu- 
anha is official in all pharmacopeias, but up to the 
present time the Pharmacopeia of the United 
States is the only one to recognize the Carthagena 
variety as being the equal of the Brazilian. 

PuLvis Ipecacuanhli:. — TJ. S. P. — Average 
dose: Expectorant, 0.050 gm. (1 grain) ; emetic. 1 
gm. (15 grains). 

Fluidexteactum Ipecacuanha. — U. S. P. 
— Fluidextract of Ipecac. — This should contain 
1.75 per cent, of alkaloids. 

Average dose: Emetic. 1 c.c. (15 minims) ; ex- 
pectorant, 0.05 c.c. (1 minim). 

PuLvis Ipecacuanha et Opii. — U. S. P. — 
Powder of Ipecac and Opium (Dover's powder). 
This contains 10 per cent, of ipecac. 10 per cent, 
of powdered opium and 80 per cent, of sugar of 
milk. 

Average dose: 0.500 gm. (7^/0 grains); used 
chiefly as a diaphoretic. 

Syrupus Ipecacuanha. — U. S. P. — Syrup of 
Ipecac. This contains 7 per cent, of fluidextract of 
ipecac and 1 per cent, of acetic acid in a mixture 
of glycerin, sugar and water. 

Average dose: Expectorant, 1 c.c. (15 min- 
ims) ; emetic, 15 c.c. (4 fluidrams) . 

ViNUM Ipecacuanha. — U. S. P. — AVine of Ipe- 
cac. A mixture of 10 per cent, of fluidextract of 



EXPECTORANTS. 275 

ipecac, 10 per cent, of alcohol, and 80 per cent, of 
white wine. 

Average dose: 1 c.c. (15 minims). 

Senega. — U. S. P. — Eoot of Polygala senega. — 
This is one of the few drugs of American origin 
that has found a place in ever}^ recent pharmaco- 
peia. It contains a saponin which is locally irri- 
tant, but which is not absorbed ; hence, the drug is 
not depressing. It is almost invariabl}^ used in 
small amount as an addition to other expectorants. 
It has the disadvantage of an unpleasant acrid 
taste. The oflficial preparations are : 

Fluidextractum SENEGiE. — U. S. P. — Average 
dose, 1 c.c. (15 minims), and 

Syrupus Seneg^e. — U. S. P. — This contains 20 
c.c. fluidextract of senega in 100 c.c. 

Average dose: 4 c.c. (1 fluidram). 

See also compound syrup of squill. 

Another irritant nauseant more notable for its 
abuse than its use is : 

Sanguinaria. — U. S. P. — Ehizome of San- 
guinaria canadensis (bloodroot). This drug, usual- 
ly omitted by modern therapeutists or dismissed 
Avith a line, contains sanguinarin, belonging to the 
morphin group, and causing depression of the res- 
piratory center. It is mentioned here more par- 
ticularly Ijecause of its widespread use by the nos- 
trum makers. The common name — bloodroot — 
appears to possess considerable psychical effect. 
'J'lie only official preparation is : 

Fluidextractum Sanguinari^e. — U. S. P. 

Average dose: 0.1 c.c. (V/^ minims). 



270 PHARMACOPEIA AA^Z) PHY8ICIAts\ 

The "Compound Syrup of White Pine" of the 
"Rational Formulary represents the "popular" ex- 
pectorant. It is not recommended, however, as it 
is too complex. - 

Antimonii et Potassii Tartras. — U. S. P. — 
Antimony and Potassium Tartrate; tartar-emetic. 
Colorless, transparent crystals or a white, granu- 
lar powder, soluble in 15.5 parts of water. This is 
the most popular and widely used of the medicinal 
compounds of antimony, and is now official in all 
recent pharmacopeias. 

Average dose: Expectorant. 0.005 gm. (1/10 
grain) ; emetic, 0.03 gm. (14 grain). 

ViNUM Antimonii. — U. S. P. — Wine of Anti- 
mony. This contains 0.4 per cent, of antimony 
and potassium tartrate dissolved in a mixture of 1 
part of alcohol and 5 parts of white wine, and en- 
ters into the well-known compound mixture of 
glycyrrhiza — a deservedly popular expectorant. 

Average dose: Of the wine 1 c.c. (15 minims). 

Tartar emetic is also an ingredient (0.3 per 
cent.) in the compound syrup of squill. 

ApomopvPHin.5; Hydrochloeidum. — U. S. P. — 
Apomorphin Hydrochlorid. — The hydrochlorid of 
an alkaloid prepared from morphin by the abstrac- 

2. The following is the formula for the Compound Syrup 
of AVhlte Pine : 

White pine bark (piuus strobus) . . . .oiiss 75 

Wild cherry bark 5ilss 75 

Spikenard i-oot 3iiss 10 

Balm of Gilead buds Siiss 10 

Sanguinaria root 3ii 8 

Sassafras bark grs. cv 7 

Morphin sulphate grs. viiss 5 

Chloroform 3iss 6 

Sugar Sxxvss 750 

Alcohol 

Water 

Syrup (U. S. P.), of each to make . .Oii lOOOi 



EXPECTORANTS. 277 

tion of one molec-ule of water. It is soluble in 40 
parts of water, in the same proportion of alcohol, 
practically insoluble in all other solvents. 

Apomorphin is much less useful as an expector- 
ant than as an emetic, its action being brief. 

Average close: Expectorant, 0.002 gra. (2 mg. 
or l/';30 grain) ; emetic, 0.005 gm. (5 mg. or 1/12 
grain). 

IPECAC. 

When the bronchi are inflamed and the secretion 
is scanty or thick and tenacious, nauseants, such 
as ipecac, lead to increased secretion which secures 
its removal by cougliing. The choice of nau- 
seants is guided by the general condition of the 
l)atient, ipecac being preferred to antimony and 
potassium tartrate in those cases (children and 
weakly persons) in which great depression would 
1)0 dangerous. The active principle of ipecac is 
not usually emploj-ed in the pure state as an ex- 
pectorant, the syrup of ipecac being preferred, as 
the tannin present retards absorption and prolongs 
the action. 

The expectorant dose of nauseants is always very 
much less than the emetic — approximately one- 
iciith or less' in the case of ipecac. "The average 
doses -given are approximate and the expectorant 
dose is to be repeated every two oi- llii-cc hours; 
the emetic dose is to be repeated half-bourly until 
.■llV.-tivc. 

For ciiiiii) in Hinall cliildi'cu Few I'cincdics enjoy 
a greati'r i'c|iu(;il ion ilmn syi'iip of ipecac, whicb 
is given alone in (|o.-es of tVom ten to tliirly di'ops, 
r('|)catcd a1 intei-\al.- of tliirt\- minutes until xoni- 
itiuL'' occurs. 



278 PHARMACOPEIA AND PHYSICIAN. 

The preparations of ipecac are seldom used 
alone as expectorants, but are usually added to 
mixtures of allied use. 

The following may be considered a typical pre- 
scription for ipecac to be used in teaspoonful doses 
every two hours; for the syrup of ipecac a corre- 
sponding amount of fluidextract or wine may be 
substituted. When an opiate is imperatively de- 
manded 15 c.c. (4 drams) of comphorated tinc- 
ture of opium may be added without other change: 

IJ. Syrupi ipecacuanhae fSvi 25 

Ammonii chloridi Siss 6 

Syrupi tolutani, q. s. ad f^iii 100 

Sig. : A teasjDOonful at a dose. 

ANTIMONY. 

Antimony and potassium tartrate is a more 
depressing nauseant than ipecac and senega. It 
may be used on robust persons, but not with safety 
on children or the infirm. Its mode of action is 
similar to that of ipecac, and here, too, we have a 
variety of official preparations. 

For the administration of antimony and potas- 
sium tartrate, the official compound mixture of 
glycyrrhiza (6 per cent, wine of antimony, 
0.024 per cent, antimony and potassium tartrate) 
is used alone or with ammonium chlorid as fol- 
lows: 

I^. Ammonii chlor 3i 4| 

Mist, glycyrrhiza; comp., q. s. ad.f^iii lOOJ 
Misce, 

Sig.: Shake the bottle and take a teaspoonful. 

Another very popular form of expectorant into 
Avliich tartar emetic enters is the compound syrup 
of squill, combining the stimulation of squill and 
the nauseant action of the tartar emetic. It may 



EXPECTOBANTS. 279 

be given alone or Avitli ammonium chlorid as fol- 
lows: 

IJ. Syrupi scillte corap f§iss 50 

Ammonii chloridi . . . 3ii 8 

Aqute, q. s. ad fgiii 100 

Misce. 

Sig. : A teaspoonful every three hours. 

STIMULATING EXPECTORANTS. 

The stimulating expectorants include a number 
of balsamic resins (of which benzoic or cinnaraic 
acid is a constituent), creosote, terebene, ammo- 
nium carbonate and to a less extent the chlorid. 

The preparations of tolu are to be regarded more 
as vehicles than as activel}- stimulating expector- 
ants. 

Squill is used as an expectorant mainl}^ for its 
nauseant effect. 

Terebene and terpin hydrate are excreted by the 
lungs and exert a mild stimulation and antisepsis, 
but the latter properly must be insignificant. 

While ammonium carbonate is distinctly stimu- 
lating, therapeutic doses of the chlorid have but 
little action on the centers. Both of these salts 
assist in the liquefaction of mucus. 

Balsamum Tolutanum. — U. S. P. — Balsam of 
Tolu is a balsam obtained from Toluifera hal- 
samum, and occurs as a yellowish-brown plastic 
solid that has a pleasant aromatic odor and a 
mild aromatic taste. It is readily soluble in alco- 
liol, nearly insoluble in water. Balsam of tolu 
was first described by Monardes, a Spanish physi- 
cian, about 1574. The drug, it is said, was col- 
lected in a district called Tolu, near Carthagcna, 
and appears to liave been well known to, and used 



280 PHARMACOPEIA AND PHYSICIAN. 

by, the natives of N'orthern South America. Bal- 
sam of toll! is widely iised at the present time and 
is official in all the leading pharmacopeias. 

Average dose: 1 gm. (15 grains). 

Syrupus Tolutanus. — U. S. P. — Syrup of 
Tolu, containing the water-soluble principles of 5 
per cent, of tincture of tolu in syrup. 

Average dose: 15 c.c. (4 fluidrams). 

TiNCTURA ToLUTANA. — U. S. P. — Tincture of 
Tolu, a 20 per cent, solution of tolu in alcohol. 

Average dose: 2 c.c. (30 minims). 

The mildest of the stimulant expectorants is 
syrup of tolu, if, indeed, this can be considered as 
anything more than a flavored syrup. The balsam 
is not frequently used in medicine, but may be 
given in the form of an emulsion made with acacia 
and water and sweetened with sugar. 

The benzoic acid and volatile oil in the balsam 
give it the advantage of Joeing mildly antiseptic, 
the syrup, however, being too weak to be effective 
in the dose usually employed. 

Balsamum Peruvianum." — U. S. P. — Balsam 
of Peru may be used in the same dose and for the 
same purpose as balsam of tolu. 

Attention is called to the fact that the urine of 
persons taking such amounts of these balsams gives 
a precipitate with nitric acid which may be mis- 
taken for albumin, but the precipitated resins dis- 
solve in alcohol, while albumin does not. 

Benzoinum. — U. S. P. — This balsamic resin is 
also a harmless stimulant, useful in bronchial irri- 
tation. 

Tincture Benzoini. — U. S. P. — A 20 per cent, 
solution of benzoin in alcohol, or: 



EXPECTORANTS. 281 

TixcTUR-V Bexzoixi Co:mposita. — U. S. P. — 
"Turlington's balsam/*' commonl}- called "Friar's 
baJsam" (containing benzoin, aloes, storax and 
tolu), may also be given. 

Average dose: 1 c.c. (15 minims) every two 
hours. 

The fact that these expectorants are harmless is 
a very great advantage — and is a point to be par- 
ticularly remembered in the treatment of small 
children, in whom opiates and such depressants as 
antimony and potassium tartrate are to be avoided. 

SciLLA. — U. S. P. — Squill. The bulb of Urginea 
maritima, containing several potent principles; it 
is exceedingly irritant and in large doses toxic. 

Average dose: 0.1 gm. (3 grains). 

Of all official drugs used in the treatment of 
cough,- few are better known than squill, the syrup 
being the most popular of its preparations. 

This drug is both stimulant and nauseant; 
hence, it is used in both stages of bronchitis. 

Syrupus Scil^LiE. — U. S. P. — Syrup of Squill. 
This represents o per cent, of squill; made from 
vinegar of squill, and, therefore, containing dilute 
acetic acid; it is, of course, incompatible with am- 
monium carbonate — a fact not infrequently lost 
sight of by the prescriber. 

Average dose: 2 c.c. (30 uiiiiiiiis). 

AcETUM SciLL.'K. — U. S. P. — A^iuegar of Squill. 
'I'his represents 10 per cent, of the drug extracted 
with dilute acetic acid. 

Average dose: 1 c.c. (15 minims). 

Flu I DKXTRACTUM SciLLyE. — U. S. P. 

Average dose: 0,1 c.c. (2 minims). 



282 PHARMACOPEIA AND PHYSICIAN. 

TiNCTURA SciLL^. — U. S. P. — This represents 
10 per cent, of the drug. 

Average dose: 1 c.c. (15 minims). 

These last three preparations of squill are sel- 
dom employed, but the following is widely used : 

Sykupus Scill.e Compositus. — U. S. P. — 
Compound Syrup of Squill (Hive Syrup). This 
represents 8 per cent, of the fluidextracts of squill 
and senega and 0.3 per cent, of antimony and 
potassium tartrate or about 0.01 gm. (1/6 grain) 
to the teaspoonful. 

Average dose: 2 c.c. (30 minims). 

Syrupus Picis Liquids. — U. S. P. — Syrup of 
Tar. — Containing one-half of 1 per cent, of the 
soluble principles of tar in syrup, is mildly stimu- 
lant and the taste is not unpleasant. 

Average dose: 4 c.c. (1 fiuidram). 

Tar itself has a disagreeable acid taste and is 
not often used in substance. 

Teepini Hydras. — U. S. P. — Terpin Hydrate. 
— This is a substance closely related to turpentine, 
camphor, etc. It occurs in colorless, lustrous, 
rhombic prisms, or a white crystalline powder, 
nearly colorless, of a slightly aromatic and some- 
what bitter taste, soluble in about 200 parts of 
water and in 10 parts of alcohol. 

Average dose: 0.1 gm. (2 grains) in capsules 
or elixir. 

Terpin hydrate has been known for some time, 
but was not used in medicine until after Lepine 
published the results of his physiologic investiga- 
tion in 1885. It is supposed to possess the anti- 
septic and stimulating effects of turpentine with- 
out possessing its irritating properties. The sub- 



EXPECTORANTS. 283 

stance soon became popular and was included in 
the United States Pharmacopeia for 1890. It is 
official in the German Pharmacopeia and in the 
French Codex. . 

Terebexum. — IT. S. P. — Terebene. — This is a 
polymerization product derived from turpentine, 
which it closely resembles. 

It is a colorless liquid, having a rather agreeable 
odor and an aromatic, somewhat terebinthinate 
taste, readily soluble in 3 times its volume of alco- 
liol, but only slightly soluble in water. 

First obtained by Soubeiran and Capitaine about 
1841, it was introduced into medicine by Dr. Wil- 
liam Murrell about 1885 ; it was made official in 
1890 and in the British Pharmacopeia of 1898. 

Average dose: 0.5 c.c. (8 minims). 

Creosotdm. — XJ. S. P. — (or Guaiacol. — U. S. 
P., which constitutes up to 90 per cent, of creo- 
sote) . 

Average dose: 0.2 c.c. (3 minims). 

Ammonii Chloridum. — U. S. P. — A white 
crystalline powder, without odor, having a cooling 
saline taste, permanent in air, soluble in 2 parts of 
water and in 50 parts of alcohol. 

As sal ammoniac, this substance has been known 
from a very early time. It is popularly supposed 
to have been first obtained from the neighborhood 
of the Temple of Jupiter Amnion, in Northern 
Africa. 

Average dose: 0.5 gm. (8 grains). 

Ammonium chlorid was known to the Arabian 
physicians and was described by Geber. It is now 
official in all pharmacopeias. Wood recom- 
mends this salt in the stage just before secretion 



284 PHARMACOPEIA AND PHYSICIAN. 

becomes free; for this purpose the following may 
be used : 

Trochisci Ammonii Chloridi. — U. S. P. — 
Each troche contains 0.1 gm. (1% grains) ammo- 
nium chlorid and 0.3 gm. (3 grains) extract of 
glycyrrhiza. 

Ammonium chlorid is much used as an addition 
to compound mixture of glycyrrhiza in the propor- 
tion of 4 gm. (60 grains) to 60 c.c. (2 ounces), 
and it may be added to nearly any expectorant 
mixture which is not strongly alcoholic. 

Ammonii Carbonas. — U. S. P. — Ammonium 
Carbonate. This consists of white, hard, translu- 
cent, striated masses of a strong odor of ammonia 
without empyreuma, and a sharp, saline taste, 
slowly but completely soluble in about 4 parts of 
water and decomposed by hot water. 

Squill in the form of the simple syrup is rec- 
ommended for use in the latter stages of bronchitis. 
The compound syrup, containing antimony, is not 
generally suited for young children, but it has been 
used in spasmodic croup. 

The use of squill as an emetic is not free from 
danger and the drug is seldom so employed alone. 

The following is suggested as a form of pre- 
scribing the syrup : 

U. Syrupi scillae fgi 30 

Syrupi ipecac f3i 4 

Ammonii chlor 3i 4 

Syrupi tolut., q. s fgiii 100 

M. et Sig. : A teaspoonful as required. 

When the inflammation affects the upper part 
of the respiratory passages it is treated with anti- 
septics, demulcents and anodynes. The lozenges 
of ammonium chlorid will be found very useful 



EXPECTORANTS. 285 

for this condition. Ammonium cliloricl is very 
commonl}'' used with the compound mixture of 
gl3-cyrrhiza, but it is not well suited for combina- 
tion with terpin hydrate, since the latter requires 
a strongly alcoholic menstruum which precipitates 
ammonium chlorid. 

Terpin hydrate has been suggested as a remedy 
in a variety of ailments, but it appears to be useful 
mainly as an expectorant, enjoying a reputation 
particularly among the nostrum venders. It is in 
reality useful in aiding to get rid of secretion from 
the bronchial mucous membrane. 

It may be prescribed as the unoflBcial Elixir of 
Terpin Hydrate and Codein Sulphate. Dose: Two 
teaspoonfuls, containing 0.12 gm. (3 grains) ter- 
pin hydrate and 0.015 gm. (^ grain) codein. 

Owing to its slight solubility in water, the elixir 
must be strongly alcoholic — a serious objection to 
its general use. It is very commonly associated 
with codein, which is not to be recommended for 
routine practice. 

Terebenc is used in much the same conditions as 
terpin hydrate, but its immiscibility with the mix- 
tures usually employed as expectorants has inter- 
fered in no small way with its employment. It 
may be proscribed in alcoholic solution, in cap- 
sules or in the lonu of an emulsion as follows: 

U. Tcrebcni Svi 25 

Pulv. acaciai 3iv 15 

Syriipi tolut f^i 30 

Aquii', q. s. ad giii 100 

Af. Ft. eimilsum. 

.Si<,'. : A tcaspoonful as required. 

Creosote is used as a stimulant expectorant. 
'I'liere is considerable diversity of opinion as to its 



28G rBARMAGOPEIA AND PHysICIAN. 

mode of action. It seems to possess little germici- 
dal action so far as the lungs arc concerned. When 
it is administered in a bland oil very large doses 
are tolerated, but these are not necessary for its 
expectorant effect. 

Numerous compounds of creosote and of guai- 
acol have been suggested as substitutes for the offi- 
cial products, but it is not probable that they pos- 
sess any decided advantages over the official. Those 
which are less poisonous are probal^ly absorbed 
from the alimentary canal to a much less degree 
than are the official creosote and guaiacol. 

Among the guaiacol compounds is the proprie- 
tary "Ethacol," containing ethyl-morphin, a fact 
to be carefully borne in mind, as the name of the 
preparation is not nearly so suggestive of morphin 
as of guaiacol. The manufacturers of this article 
recommended morphin or ethyl-morphin in bron- 
chitis for increasing secretion ! 

A condition deserving especial mention is that 
in which the mucus is particularly thick and tena- 
cious, requiring liquefaction; for this purpose, 
ammonium carbonate is frequently added to other 
expectorants; it has the disadvantage of an un- 
pleasant taste, which can not be disguised with di- 
luted acids because these decompose the carbon- 
ates. 

The cough of chronic bronchitis requires the 
use of one of the stimulant expectorants, such as 
terebene or terpin hydrate, bearing in mind the 
avoidance of those which will prove objectionable 
with continued use. 

While urging the advantage of using the phar- 
macopeial expectorants, we particularly suggest 



EXPECTORANTS. 287 

that the physician consider the several ingredients 
of any nostrum instead of accepting the ahsnrd, 
and often grotescjue. claims of the maniifactnrer. 

AXODYNES. 

When the irritaljilitv of the throat causes exces- 
sive coughing, anodynes are indicated. 

The pharmacolog}' of morphin, codein and some 
of the morphin derivatives will he discussed hriefly 
in the succeeding chapter, hut we wish to reiterate 
the oft-repeated warning concerning the indis- 
criminate use of the drugs of this class which do 
uncjuestionahly relieve coughing, thus giving the 
patient the impression that he is being cured, 
whereas the inflammatory process may be progress- 
ing. The derivatives of morphin, such as codein 
and heroin, lessen the irritability of the center 
without causing so much gastrointestinal disturb- 
ance as morphin. Morphin is particularly to be 
avoided when the cough is attended with free 
secretion, since the cough is necessary in that 
event. 

CoDEiXA. — U. S. P. — Codein. Very sohible in 
alcohol, much less soluble in water. 

Codeix.t: Pitospilvs. — U. S. P. 

CoDEiN.E Sulphas. — U. S. P. — Both are quite 
sohible in water, but not in alcohol. 

Average dose: 0.03 gm. (30 mg. or i/> grain). 

AciDUM Hydhocyanicum Dilutum. — U. S. P. 
— Contains 2 per cent, absolute HCN. 

Average dose: 0.1 c.c. (1^2 minims). 

Syi!('!'['w Pifrxr VrifoixiAX-i:. — IT. ,S. P. — 
Syriip of Wild CImtit ivpivsciits i:. per (■•■iit. of 
bark and l."J per cent, of glycerin. 



288 PHARMACOPEIA AND PHYSICIAN. 

. Codein imdoiibtedly lessens cough, but, as al- 
ready stated, this is not always desirable. Codein 
phosphate or sulphate, being soluble in water, may 
be added to almost any cough mixture which is 
not alkaline. 

The following is suggested as a simjile prescrip- 
tion containing codein: 

IJ . Codeinse sulph gr. viii 5 

Ammonii chloridi Siss 6 

Syrupi priini virg., q. s. ad fgiii 100 

M. Sig. : A teaspoonful every two or three hours. 
Compound mixture of glycyrrhiza, syrup of tar, syrup 
of squill or syrup of tolu may be substituted wholly or 
in part, for the syrup of wild cherry. 

Codein, rather than its salts, is suited for com- 
bination with tcrpin hydrate, since both require al- 
cohol as solvent. 

Codein has come very largely into use in expec- 
torant mixtures in recent years, partly because its 
action resembles that of morphin without disturb- 
ing digestion or causing constipation in moderate 
doses, partly, no doubt, because manufacturers 
have popularized it in order to avoid the stigma 
attaching to the general use of morphin and opium. 

Numerous substitutes have been introduced for 
morphin and codein, but it has not been demon- 
strated that they possess all the advantages and 
none of the disadvantages of the officials. It must 
not be forgotten that the habit may be formed 
with any of the morphin derivatives, including 
codein. 

The bromids of ammonium, potassium and so- 
dium are safer than morphin, and are frequently 
beneficial when anodynes are indicated. Their 



EXPECTORANTS. 289 

doses should^ however^ be more than proportion- 
ately reduced for children. 

Hydrocyanic acid may he added to expectorant 
mixtures, hut its action is fleeting and it must 
be frequently repeated. 

DEirULCENT EXPECTOEANTS. 

Demulcents are frequently employed to allay the 
irritation of the mucous membrane, and they pos- 
sess the great advantage of being harmless. They 
may be administered in the form of lozenges or 
troches. 

The following demulcents may be used as ve- 
hicles : 

SyRUPUS ACACIiE. — TJ. S. P. 

MuciLAGO Acacia. — TJ. S. P. 

Glycyrritiza. — TJ. S. P. — Licorice Eoot is so 
well known as to require Imt little comment. Its 
preparations afford a variety of forms for adminis- 
tering it. 

Fluidextractum GLYCYRRHizJi:. — U. S. p. — 
This is the Fluidextract of Licorice Eoot, from 
which a satisfactory syrup may be prepared by 
mixing 25 c.c. of the fluidextract with enough 
syrup to make 100 c.c. 

Average dose: 2 c.c. (30 minims). 

EXTRACTUM GLYCYRRiriZin; PURUM. — TJ. S. P. 
— This is a semi-solid extract prepared from the 
root and is well adapted as an addition to extem- 
poraneous mixtures. 

,\vcrage dose: 1 gm. (15 grains). 

Trociiisci Glycyrrhiz^ et Opii. — U. S. P. — 
Those contain 0.005 gm. (5 mg. or 1/12 grain) 
of opium. 



290 PHARMACOPEIA AND PHYSICIAN. 

Glycyrrhizinum Ammoniatum. — U. S. P.— 
Ammoniated Glvcyrrhizin is an excellent demul- 
cent; it is readily soluble in water, but incompati- 
ble with acids. 

Average dose: about 0.25 gm. (4 grains). 

PuLvis Glycyrrhizje Compositus. — XJ. S. P. 
— Compound Powder of Glycyrrhiza, a laxative, 
containing senna, washed sulphur, glycyrrhiza, 
sugar and oil of fennel, and popularly believed 
to be a desirable adjuvant to expectorant medi- 
cines. 

Average dose: 4 gm. (GO grains). 

]\IlSTURA GLYCYRRHIZiE COMPOSITA. U. S. P. 

— Compound Mixture of Glycyrrhiza, brown mix- 
ture, containing purified extract of glycyrrhiza 
and acacia, each 3 per cent., syrup 5 per cent., 
with camphorated tincture of opium 13 per cent., 
wine of antimony 6 per cent, and spirit of nitrous 
ether 3 per cent. 

Average dose: 8 c.c. (2 fluidrams). 

This is a deservedly popular expectorant. It is 
very often prescribed alone, but is also much used 
as a vehicle for other expectorants, particularly 
ammonium chlorid. 

The demulcents are useful when they may be 
applied directly to the seat of the inflammation, 
but they are of less service when the lower pas- 
sages are affected. 

The Mistura Ammonii Chloridi, N. F., affords 
an example of the use of a demulcent as a vehicle. 
It consists of 21/2 per cent., each, of ammonium 
chlorid and purified extract of glycyrrhiza with 
water. The average dose is two teaspoonfuls. 



CHAPTEE XIII. 

AXALGESICS AND SOPORIFICS. 

Analgesics and soporifics are among the most 
important articles in the materia medica, and at 
the same time, owing to their abuse, among the 
most harmful. 

Pain, accompanied by sleeplessness, oecurs in a 
great variet}' of conditions, often with an inten- 
sity or persistency that imperatively demands alle- 
viation. When such a condition requires medi- 
cines for a long time there is danger that the pa- 
tient will learn the name of the remedy employed 
and continue its use after the actual necessity for 
it has passed. Certainly no other class of reme- 
dies requires more painstaking care on the part 
of the physician, not only in the choice of the par- 
ticular agent to be used, but also in the regulation 
of the dose. 

The only way to secure the best results in the 
treatment of such conditions is by acquiring an in- 
timate knowledge of the various remedies in this 
class and by learning how to use them singly or 
in combination as may be required. 

In a given case a combination of hydraled eliloi'al 
and potassium bromid iiiny be necessary, while in 
another the bitter alniie may suffice. The more 
(hirigeroiis hvdratcd chloi-d should nevei' be used 



292 PHARMACOPEIA AND PHYSICIAN. 

when the less liarniful bromid will serve the pur- 
pose.^ 

If we find that scarcely any two successive pa- 
tients demand exactly the same prescription of but 
two ingredients, how very much less is the proba- 
bility of finding any considerable number each re- 
quiring a "shotgun" prescription of five or six 
substances of widely different action, agreeing only 
in the one property of producing unconscious- 
ness. 

It should be obvious that the conscientious use 
of analgesics and soporifics demands the thought- 
ful selection of the remedy with the careful com- 
putation of the dose according to the necessities 
of the individual case — a condition manifestly im- 
possible when one relies on complex, ready-made 
mixtures, with doses and indications suggested by 
an interested layman — the manufacturer. The 
greater the number of individuals who acquire 

1. Should the physician desire to use a compound mixture 
of hydrated chloral and potassium bromid of the bromidia 
type he may have the "Mistura Chloralis et Potassii Bromidi 
Composita" of the National Formulary compounded, as fol- 
lows : 

R. Chlorali hydrati 

Potassii bromidi. aa 5i-gr. xv 5 

Ext. cannab. ind. 

Ext. hyoscyami, aa gr. % 04 

Aquse q. s. ad 5vi 25 

The hydrated chloral and the potassium bromid are dis- 
solved in a little water and the extracts are then dissolved 
in the solution of the salts mixed with some powdered pumice 
stone, and the mixture filtered. 

Each teaspoonful will contain approximately 1 gm. (15 
grains) each of hydrated chloral and potassium bromid ; 
0.008 gm. (Vs gr.) each of extract of Indian cannabis and 
extract of hyoscyamus. 

The mixture should be used with caution, and it will 
usually be found advantageous to omit the extract of Indian 
cannabis. 

This mixture is unscientific in the extreme and we do not 
commend its use. 



AXALGESICS AXD SOPORIFICS. 293 

such harmful habits the greater are the profits of 
the nostrum maker. 

It is -well known that the habitual use of opium, 
hydrated chloral, the bromids and other narcotics 
is widespread, but there are few who appreciate 
the full extent of these practices, or in how far 
physicians are responsible because of the careless 
use of these agents, either in simple form or as an 
ingredient of some nostrum. 

For convenient consideration we shall divide 
these remedies into opium, atropin, acetanilid, 
hydrated chloral and bromid groups, the first 
three being more properly analgesics and the last 
two soporifics, though no absolute distinction can 
be drawn 1)etween them. 

MORPHIN. 

The importance of opium and morphin are such 
that their actions and uses should be carefully 
studied in standard works of the day, an^ we shall 
pass to the minor members of the group after 
discussing the official preparations briefly. 

Morphin constitutes about one-eighth of the 
weight of opium, the therapeutic properties of 
whicli it represents fully; hence we shall consider 
the pharmacology of the alkaloid briefly. 

The action of morphin on the central nervous 
system has been compared to the "law of dissolu- 
tion," the higher centers being affected first, reason 
and judgment are impaired, the sensitiveness to 
constant pain is diminished, and the patient be- 
comes drowsy, falls asleep or sinks into a coma- 
tose condition dependent on the dose. It is a curi- 
ous fact that, despite the lessened sensibility to a 



294 PHARMACOPEIA AND PHYSICIAN. 

constant stimulus, such as pain, there may be, 
after moderate doses, a hypersensitiveness to l)right 
flashes of light and sharp noises. 

The widespread use of opium and morphin for 
local action — injections and lotions — is based on 
an erroneous idea. Opium contains gum which is 
a demulcent, a rather expensive one, however, 
while its active principle, morphin, must be ab- 
sorbed before it can produce its effects, which arc 
constitutional, not local. 

The excitement caused by morphin, in some pa- 
tients, is explained by the fact that reason and 
judgment, which under normal conditions impose 
restraint, are in abeyance, and not by any stimula- 
tion by the drug. 

The cat reacts to morphin by an extraordinary 
degree of excitement and the theory of the abey- 
ance of self-imposed restraint as suggested in man 
is not a satisfactory explanation of this excitement 
in the cat. 

Stimulation of the cord sometimes follows the 
use of morphin in children, and, after large doses, 
in the frog this gives rise to strychnin-like convul- 
sions. 

Small doses of morphin depress the respiratory 
center, causing a much slower and somewhat deep- 
er respiration, but the volume of respiration is 
markedly diminished. The depression of this cen- 
ter explains the use, and also the contraindications 
of opiates in cough. 

Morphin exerts very little influence, in moder- 
ate doses, on the other medullary centers, so that 
the heart and blood pressure are not materially 
affected, except indirectly as the result of nausea, 



ANALGESICS AXD SOPORIFICS. 295 

when that occurs, but there is a dilation of the 
cutaneous vessels of certain regions, particularly 
of the head and face. The seat of this action is 
not determined with certainty, but it probably ex- 
plains the diaphoretic action of opium. 

The secretion of mucus is usually diminished, 
except in the case of nausea. The urine is not af- 
fected appreciably, but the bladder may become 
distended owing to the loss of reflex from the 
sphincter. 

Small doses of morphin lessen peristalsis, while 
an enormous dose given to a. dog results in vomit- 
ing and diarrhea. These actions are not fully 
understood, but it seems probable that the action 
is partly central, though mainly local. The effect 
of the reflex mechanism in the intestinal wall 
diminishing peristalsis in the one case and irrita- 
tion of the intestine during excretion causing the 
diarrhea. Against this latter and in favor of the 
participation by the center is the rapidity of ac- 
tion after subcutaneous injection. 

The toxicology of morphin is important because 
of the frequency with which it is taken with suici- 
dal intent. The tincture of opium perhaps' is the 
preparation most frequently used for that purpose, 
and when this is swallowed the odor may, usually, 
be detected in the breath. 

Morphin is excreted from the blood into the 
stomach and intestine; hence the stomach should 
1)0 washed out in all cases of opium and morphin 
poisoning, regardless of the method of adminis- 
tration, and particularly when the case is seen 
early. When the stomach has been emptied of 
food, a very dilute solution of potassium perman- 



296 PHARMACOPEIA AND PHYSICIAN. 

ganate should be added to the water used in wash- 
ing that organ. 

Death, in cases of morphin poisoning, results 
from failure of respiration, and, after evacuating 
the stomach, measures of relief are directed to 
sustaining the respiratory center. Caffein, by hypo- 
dermic injection, or, better, by very strong hot tea, 
made quickly, not by long standing on the leaves, 
or strong hot coffee, stimulates the respiratory cen- 
ter directly, also indirectly and more beneficially, 
by increasing the blood pressure and, therefore, 
the circulation in the respiratory center. The head 
may be lowered if the patient is asleep. Violent 
measures, such as enforced motion and painful 
slapping, stimulate the respiratory center, but they 
also increase the work and help to exhaust it, and 
should not be used. 

Strychnin injected subcutaneously, but no more 
than the therapeutic dose, should be given, but this 
must not be repeated. Warm, not hot, tea or coffee 
may be absorbed from the intestine when the pa- 
tion can not be aroused. 

Unlike most alkaloids, morphin is not excreted 
in the urine; hence diuretics are useless for hasten- 
ing elimination. 

Codein is methyl-morphin. Morphin appears to 
have the formula: 

/.N(CHOCH„ 

C,,H,o(OH), 

\OCH2 
and codein has a similar formula, except that an 
OCH3 group replaces one of the CH groups. 

Dionin is ethyl-morphin and heroin is di- 



ANALGESICS AXD SOPORIFICS. 297 

acet3'l-morphiii ; in the latter case both CH groups 
have been replaced. 

Cushn}' states that most impartial observers have 
failed to obtain better results from heroin and 
dionin than from morphin and codein in coughs, 
and that further investigation is required before 
they can be recommended as being superior to the 
older and better known alkaloids. 

The action of codein resembles that of morphin 
in a general way, but it is much weaker. It has 
less of the narcotic and more of the stimulating 
action on the cord. The respiratory center is not 
depressed to the same extent and there is less in- 
terference witli peristalsis. 

The danger that the patient Avill form the truly 
terrible opium habit from even a short use of the 
drug or of any of its derivatives should always 
Ijc Ijorne in mind, and when it is necessary to use 
tliem they, should be masked. Hypodermics in 
pain have come to be almost synonymous with mor- 
phin in the minds of the laity. This idea should 
1)0 uprooted both l)y the use of the method for 
many other substances and by avoiding it as much 
as possiMc willi morphin. The odor and the taste 
of opium and dT the tincturC; unfortunately, are 
well known and tlicy should be disguised if possi- 
ble. 

'I'o disguise the identity of opium and its pre"|D- 
arations it is customary with some practitioners to 
employ the old designation thebaica for opium, 
tincture tliebaica for the tincture. The use of the 
deodorized preparations of opium is also to Ije rec- 
ommended for this purpose. 



298 PHARMACOPEIA AND PHYSICIAN. 

The official titles coining under the heading 
opium are numerous and important. Opium and 
granulated opium are never used directly in the 
practice of medicine, but powdered opium and 
deodorized opium are frequently prescribed. 

Opii Pulvis. — U. S. P. — When assayed, by the 
process given in the Pharmacopeia, this .should 
yield not less than 13 per cent, nor more than 12.5 
per cent, of crystallized morphin. This require- 
ment is somewhat higher than the provision 
adopted for the International Standard, which 
limits the morphin contents of powdered opium to 
10 per cent. 

Average dose: U. S. P. powdered opium is 
0.050 (50 mg. or 1 grain). 

Opium Deodoratum.- — U. S. P. — This is pow- 
dered opium which has been treated with purified 
petroleum benzin to remove the caoutchouc, wax, 
oil and the odorous substances that are present; 
the alkaloidal strength and the dose of deodorized 
opium are the same as for the official powdered 
opium. 

ExTRACTUM Opii. — IT. S. P. — Assayed to con- 
tain 20 per cent, of morphin. This preparation is 
now little used, except in suppositories and the 
official opium plaster. 

Average dose: 0.30 gm. (30 mg. or % grain). 

Pilule Opii. — U. S. P. — These are each com- 
posed of opium, 0.065 (1 grain), and soap 0.020 

2. This preparation is superior to the widely used pro- 
prietary preparation of opium "Svapnia," over which it has 
the advantage of economy, activity and even general reliabil- 
ity, since the accompanying directions for assay are not 
alone accurate, but are readily followed by any one versed 
in chemical assay work. 



AX ALGESICS AXD SOPORIFICS. 299 

(1/3 grain). . These pills constitute a very ancient 
form of administering opium. 

There are five liquid preparations, the least use- 
ful of which will Ije mentioned first : 

ViNCii Opii. — U. S. P. — Containing 10 per 
cent, of opium in fortified white wine, aromatized 
with 1 per cent., each, of cinnamon and cloves. It 
rcsemhles the well-known "Laudanum of Syden- 
ham.^' 

Average dose: 0.5 c.c. (8 minims). 

AcETUM Opii. — U. S. P. — Vinegar of Opium, 
formerly known as hlack drop, Lancaster drops or 
Quaker drops, has long heen known and extensively 
used. It contains 10 per cent, of opium and 3 per 
cent, of nutmeg in diluted acetic acid, sweetened 
with sugar. 

Average dose: 0.5 c.c. (8 minims). 

TixcTCRA Opii. — U. S. P. — Tincture of Opium 
is the well-known and widely used laudanum, and 
consists of 10 per cent, of opium in diluted alco- 
hol. 

Average dose: 0.5 c.c. (8 minims). 

TiNCTURA Opii Camphorata. — U. S. P. — This, 
also known as paregoric or paregoric elixir, is the 
most widely used of the compound preparations of 
opium now official. It is so well known as a mild 
anodyne and sedative tliat further notice is not 
necessary. 

Average dose: 8 c.c. (2 fluidrams). Tliis amount 
contains al)Out 0.03 gm. (i/> grain), oacli, of pow- 
dered o|)iiiin. henzoif neid. (■;iiii]ili(ir nnd oil (if 
anise. 

TixcTURA Oi'ii i)i:oi)(»i;A'ii. — U. S. I'. — Deo- 
dorized Tincture of ()j)iuin is ))ractically a 10 per 



300 PHARMACOPEIA AND PHYSICIAN. 

cent, aqueous extract of opium that has been 
treated with purified petroleum benzin to remove 
tlie odorous and other objectionable constituents, 
and subsequently preserved by the addition of 20 
per cent, of alcohol. This, like the simple tincture 
of opium, is directed to yield, on assay, not less 
than 1.2 per cent, uor inore than 1.25 per cent, of 
morphin in crystals. The average dose is 0.5 c.c. 
(8 minims). 

While there has been some controversy con- 
cerning the origin of this particular preparation, 
there has never been any difference of opinion 
as to its potency for harm. From the sedative 
elixirs of nearly a century ago to the Scotch oats 
essence of the present day there have been many 
attempts to exploit deodorized or masked opium 
preparations, as harmless vegetable compounds. 
Another class of preparations, like "McMunn's 
Elixir of Opium,-' has been exploited as em- 
bodying some wonderful discovery in the treat- 
ment of opium.^ The official deodorized tinct- 
ture is in every way distinctly superior to all of 
these nostrums, because, as noted under deodorized 
opium, it has the advantage of economy, efficiency 
and reliability. 

There are but three other galenical preparations 
of opium official in the present Pharmacopeia. 



3. "Papine" would be a gem among these if the claims 
made for it were true, but we can not believe that any prep- 
aration of opium containing the pain relieving principle 
(which we know to be morphin) can be "a safe opiate for 
children under one year." This affords a good example of 
the audacity of the nostrum vendor who seeks to delude 
the physician and induce him to foster such vicious habits 
even in the cradle. 



ANALGESICS AXD SOPORIFICS. 301 

TixcTDRA Ipecacdaxhje et Opii. U. S. P. 

Liquid Dover's powder. This is of practical!}- the 
same strength as the well-known powder of ipecac 
and opium. 

Average dose: 0.5 c.c. (8 minims). 

PuLvis Ipecacuanha et Opii. — U. S. P. — 
This has been noticed under ipecac (see Chapter 
IX). It contains 10 per cent., each, of ipecac and 
of powdered opium. 

Average dose: 0.500 gm. (Ti/o grains). 

TiiocHisci Glycyrriiiz.t^ et Opii. — U. S. P. — 
These have been previously noticed. 

The alkaloids, morphin and codein. are of near- 
ly as much interest as opium. 

Morphin was discovered by Sertiirner, a German 
apothecar)', in 1805, and was used in medicine as 
early as 1820. Tliere are four official prepara- 
tions : 

MoKPiiiXA.— r. S. p.— This alkaloid, ohtainiMl 
from opium, occurs as colorless or white shining 
rhombic prisms or as fine needles or as a crystal- 
line powder. It is odorless and has a bitter taste. 

Average dose: 0.010 gm. (1/5 grain). 

MoHPiiix.i-: Acetas. — I'''. S. P. — This salt of 
morphin should be kept in well-stoppered, dark 
amber-colored bottles, and a minute quantity of 
free acetic aeiil slioulil he ju'eseiit to ])revent de- 
composition. 

Average dose: O.dl.') oi,,. ( i 'j ui-iin). 

MOIU'IIIX.K IlVDItOCIILOUIDl A[. 1". S. P. 

Like tlie acetate, this should be kept in well-stop- 
|)ere(l dark bottles. 

.\vei-age dose: 0.015 gin. {% grain). 



302 PHARMACOPEIA AXD PHYSICIAN. 

MoRPHiN.^; Sulphas.— U. S. P.— Like the 
other morphin salts, this should he kept in well- 
stoppered dark bottles. 

Average dose: 0.015 gm. (14 grain). 

Sulphate of morphin is much the most fre- 
quently used in this country, while the hydro- 
chlorid is generally given the preference in Eu- 
rope. The acetate is the most readily soluble in 
water, but is quite unstable, losing acetic acid on 
exposure to the air, and, as the alkaloid morphin 
requires 3,300 parts of water for solution at or- 
dinary temperatures, considerable care should be 
exercised in the use of old, and possibly decom- 
posed, samples of morphin acetate. 

While the new Pharmacopeia gives 0.015 gm. 
(1/4 grain) as the average dose of the salts of 
morphin, we believe that this is too high as the 
"average" dose. 

Codein and two of its salts are official : 

CODEINA.— TJ. S. P. 

CODIEN^ PhOSPHAS. — JJ . S. P. 

CoDEiNJi: Sulphas. — U. S. P. 

Average dose (of either) : 0.03 gm. (1/2 grain). 

Codein, in addition to being obtained from 
opium, is also prepared from morphin by methyl- 
ation. It was discovered by a French chemist, E. 
Eobiquet, in 1832, but was not generally used in 
the practice of medicine until many years later. 
It was admitted into the U. S. Pharmacopeia in 
1880; the phosphate and the sulphate are now 
official for the first time. The sulphate is the form 
most frequently employed in this country, though 
it appears to be but little known abroad, where 
the phosphate is mainly used. The phosphate was 



AX ALGESICS AXD SOPOBIFICS. 303 

considered under "Expectorants." Codein has been 
considered a somewliat uncertain drug, owing to 
its frequent contamination with morphin, but the 
Pharmacopeia provides a test for its purity, and 
particuhirly for detecting the presence of the more 
poisonous alkaloid. 

The phosphate being readily soluble in 2.5 parts 
of water, is particularly well suited for hypoder- 
mic use ; or it may be prescribed alone in syrup or 
combined with hydrated chloral or the bromids ; in 
the latter case the mixture should be directed to 
be shaken before using. 

The average dose of codein or of any of its salts 
is 0.03 gm. (30 mg. or % grain). 

Apomorphix.e Hydrochloridum. — XJ. S. P. — 
which was also mentioned under "Expectorants," 
lias been recently brought to notice as a hypnotic, 
in doses of 0.002 gm. (1/30 grain). It is said to 
have the great advantage of not producing a drug 
habit. 

Heroin and dionin are proprietary names for 
articles of the morphin group possessing some ad- 
vantages, but they are not free from danger. Tlie 
heroin habit is beginning to be common and sliould 
be carefully guarded against. 

Cannabis Indica. — U. S. P. — Indian Canna- 
bis is a well-known member of the opium group, 
ft occurs in dark-green or brownish compressed 
masses, having an agreeable narcotic odor and 
cliaracteristic taste. 

It appears to Imvc liccn ii.-cil Ity the Hindoos 
Iroiii very early iiiiio. It was also known to tin- 
Egyj)tians and to J)ioscoriil( >. Imt it wa.s not in- 
troduced into England until al)out 1.S35. 



;{04 PHARMACOPEIA AND PHYSICIAN. 

Average close: 0.05 gm. (1 grain), but rarely 
used in substance. 

EXTRA.CTUM Cannabis iNDicyE.— U. S. P. 

Average dose: 0.01 gra. (10 mg. 1/5 grain), 

Fluidextractum Cannabis Indict. — U. S. P. 

Average dose: 0.05 c.e. (1 minim). 

TiNCTURA Cannabis Indict. — U. S. P. — rep- 
resents 10 per cent, of the drug extracted with al- 
cohol. 

Average dose: 0.5 c.c. (10 minims). 

At one time Indian Cannabis was supposed to 
have great virtues as an antispasmodic, analgesic 
and narcotic, and it was highly recommended by 
a few ph3'Sicians as a vasomotor stimulant, uterine 
stimulant, etc. It is now but little used and there 
seem to be few conditions in which one of the prep- 
arations of opium could not be used advantageous- 
ly in its stead.* 

Two other members of the opium group are 
sanguinaria, which we have had occasion to men- 
tion elsewhere, and the feebly-acting 

4. It may be worth while to notice the importance at- 
tached to the extract of cannabis indica by the makers of 
bromidla, who claim that their preparation is the only hyp- 
notic that has stood the test in every country for thirty 
years. Since all the other constituents are very commonly 
used, one must infer that they considei: the genuine im- 
ported extract of cannabis indica of exceptional value. 
Bromidla, it is claimed by the manufacturer, contains 15 
grains each of hydrated chloral and potassium bromid, and 
Vs grain each of genuine imported extract of cannabis indica 
and extract of hyoscyamus. to the teaspoonful. Thus a sin- 
gle repetition of the dose — one teaspoonful — might prove 
fatal, since 30 grains of hydrated chloral have caused death ; 
but the manufacturers advise hotirUj doses so long as may be 
necessary to induce sleep. The extravagant claims made by 
the manufacturers of this nostrum liave induced many physi- 
cians to use it in preference to prescribing the several offi- 
cial constituents according to individual needs, and today 
it is offered direct to the public at cut-rate prices. 



AXALGESICS AXD SOPORIFICS. 305 

LACTTCARIUil. — U. S. P. 

Average dose: 1 gm. (15 grains). 

TixcTURA Lactucaeii.^ — U. S. P. — This is a 50 
per cent, preparation of lactucariiim made with 
diluted alcohoh 

Average dose: 2 c.c. (30 minims). 

Syrupus Lactucarii. — U. S. P. — This is much 
more commonly employed than the tincture, its 
popularity heing largely due to a nostrum. 

Average dose: 8 c.c. (2 fiuidrams). 

The indications for opium and niorphin are too 
varied for anything like a comprehensive treatment 
here. This is well illustrated hy the remark of 
S^-denham, who said that few Avould he callous 
enough to practice therapeutics without opium. 
We should always rememl)er, however, that no 
drug is more frequently misused or lends itself so 
readily to ahuse as opium and its derivatives. 

Pain calls for opium. Bearing in mind its nu- 
merous disadvantages and po.?sibilities for harm, 
this is the principal guide to its emplo3'ment. 
Cough, at certain stages, ' diarrhea, severe colic, 
especially lead colic, inaccessible hemorrhage and 
conditions calling i'oi- a diaphoretic (with ipecac), 
are among Die numerous indications for its use. 

For sleeplessness, in the absence of pain, luor- 
phin is not nearly so useful as chloral and (lie 
l.n.niids. Tb.' (lan.ucr of cv.'U very small doses ..!' 
niorjjliin and o|iiiiiii I'oi- children must he lionic 
in mind constant Iv. jiikI parents should lie llioi'- 
oughly warned ol' the (lungers of soolJiinu' syi'ups. 
A single drop of tinelure of (ipiimi is snid Id liavo 
proved fatal to a child under 1 year of age. 



300 PHARMACOPEIA AND PHYSICIAN. 

THE ATROPIN GROUP. 

The atropin group includes the crude drugs 
yielding the mydriatic alkaloids, such as atropin, 
hyoscvamin and hyoscin, or sdopolamin, all of the 
latter heing closely related chemically. 

The actions of atropin and its congeners are so 
important and so complex that it is entirely beyond 
the scope of the present article to attempt any- 
thing like a complete description of them. 'The 
reader can not avail himself of this potent and im- 
portant class of agents without a careful study of 
their pharmacologic and therapeutic actions. We 
shall, therefore, call attention to a few of the more 
important applications and contraindications with- 
out entering deeply into the reasons. 

Atropin is not nearly so important as an anal- 
gesic as morphin, but it has a variety of uses, sev- 
eral of which will be considered now, while others 
will be discussed under circulatory stimulants. 

Atropin is useful as an analgesic mainly when 
the pain is of spasmodic origin and when the appli- 
cation may be made directly to the nerve ends of 
the affected tissues. In the pains of lead colic 
this mav be accomplished by the internal u.se of 
one of the preparations of belladonna, preferably a 
pill of the extract coated with salol or keratin. 

Atropin stimulates the central nervous system, 
being antagonistic to morphin to a considerable 
degree. The stimulation of the medulla is much 
the more important in therapeutics. 

Atropin paralyzes the terminations of nerves 
concerned in nearly all the body secretions (mucus, 
saliva and gastric juice, but not the pancreatic), 
the vagus endings in the heart (besides those con- 



i 



AXALGESICS AXD SOPOBIFWS. 307 

ccrned in secretion), and most- endings in plain 
muscle, except those in the vessels. 

The influence of atropin on peristalsis is not 
positively determined. l)ut it seems probable that 
it only prevents colic pain caused by purgatives 
without interfering Avith peristalsis. 

Among the results of the action of atropin arc : 
mental excitement,'" increased respiration (respira- 
tory center), dryness 'of throat (mucous glands), 
dilation of the pupil (endings in circular muscle), 
rapid heart (vagus depression), increased blood 
])ressure (vasomotor stimulation). Atropin de- 
]n-esses sensory endings in the skin when applied 
locally, but not after internal use. 

The most prominent action of atropin is seen in 
the dilation of the pupil, but the more rapidly act- 
ing and less enduring homatropin hydrochlorid is 
usually preferred for this purpose, if the object is 
merely to examine the eye — atropin, if it is de- 
sired to paralyze accommodation for some time, as 
in inflammatory conditions. 

While the mydriatic effect is so similar with the 
different members of this grou]). it must l)e re- 
membered that tliey have very dissimilar actions 
on the brain. 

The crude drugs and their ])reparations belong- 
ing to this class are so numerous and so well known 
that it is hardly necessary to enumerate them. Be- 
sides r)clhi(l(iiiii;i Konl niid Leavcs, Hyoscyamus 
and Straiiiniiiuin l.caxcs. a nieinber now official for 
the first time, is 8coj)ola. 

Scoi'OLA. — U. S. p. — The di'icd rjiizome of 
ScojKihi. ((irninlicd (.]a(i|uiii) ( I^'ain. Solanacaa'), 
vielding. when assayed as directed in the Pharma- 



;50S PHARMACOPEIA AND PHYt^ICIAN. 

copeia, not less than 0.-") per cent, of its alkaloids, 
has little odor and a sweetish, afterward bitterish, 
acrid taste. Though described bv Dr. Scopoli in 
1771, it attracted but little attention from the 
medical profession until it was used in manufac- 
turing "belladonna" plasters. 

Average dose: 0.04 gm. (2/3 grain). 

FlUIDEXTRACTUM SCOPOL.I^.^-U. S. P. 

Average dose: 0.05 c.c. (1 minim). 

Scopolamin.t: Hydrobromidum. — U. S. P. — 
This is chemically, and otherwise, identical with 
Hyoscinffi Hydrobromidum, U. S. P. See also 
Chapter XI. 

It has been used in the treatment of nervous 
excitement, particularly of the insane. It often 
induces quiet sleep at night — not usually in the 
day — and may also lessen sexual excitement. 
Atropin, on the other hand, has been used to stim- 
ulate the brain in cases of depression. 

Average dose: 0.005 gm. (0.5 mg. or 1/125 
grain). 

Hyoscyamin^e Hydrobromidum, IT. S. P.. and 

Hyoscyamhs^.e Sulphas. — TJ. S. P.^These are 
used very much as scopolamin is. 

Average dose: 0.005 gm. (0.5 mg. or 1/120 
grain). 

Xone of the mydriatic alkaloids should be used 
as soporifics except in case of urgent need, a.s the 
benefits -may be more than counterbalanced by the 
disadvantages. Hyoscin or scopolamin and hyos- 
cyamin are of little use directly in relieving pain; 
hence, they can hardly be considered as analgesics. 

Anv of these alkaloids mav be given alone as 



ANALGESICS AXD SOPORIFICS. 309 

taljlet triturates or as compressed tablets, hypoder- 
mically or alone in aqueous solution. 

The following is a common method of exhibit- 
ing belladonna, particularly in asthma : 

1$. Tinctume belladoiinae fol. I 

TiiK-tura? lobeliie. aa f3ii 10| 

Spiritus aetheris nitrosi, q. s. ad. .fBiii lOOJ 

Of this a teaspoonful is given every hour or two 
until relief is obtained. 

The In-omids of ammonium, sodium or potas- 
sium may be used with the prescription given, but 
in that case adjuvant or aromatic elixir should be 
suljstituted for the spirit of nitrous ether, and, as 
in every case when bromids or iodids are combined 
with alkaloids, the mixture is directed to be shaken. 

The extracts of the crude drugs are much to be 
preferred to the alkaloids as additions to purga- 
tives, since the latter would be largely absorbed 
from the stomach, whereas the local action on the 
intestine is desired. 

TTTE AC'KTAXILID (ilJOUP. 

Phciiacctin. antijjyiin and acotauilid reduce the 
febrile temjieraturc through their action on the 
heat-regiilating center. This reduction is due to 
increased heat loss mainly, for the lessened pro- 
duction of heat folloirs the change. The increased 
loss of heat is accoiii|ilish(d by the dilation of the 
cutaneous vessels, intlicr llian by sweating, for it 
occuis wIkii -wcjilinu- is prevented Ijy the use of 
alropiii. The dilation is of central origin and 
does not affect the splanchnic area, the lilood ])res- 
suro being affected but little. 

'IMierapeutic doses of the antipyretics increase 
the heart rate somewhat at first, but tiiis is unim- 



310 PHARMACOPEIA AND PHYSICIAN. 

portant, and when the fever abates from any cause 
the pulse and the respiration become slower and 
stronger. 

Ver}' large doses induce sleep, then convulsions, 
cyanosis and collapse. 

Small doses relieve headache and neuralgia, but 
their mode of action is unknown. 

Acetanilid is rapidly, phenacctin slowl}', oxi- 
dized in the body with the formation of para- 
amido-phenol or a closely related substance, which 
acts on the hemoglobin of the blood, forming 
methemoglobin, and to this the cyanosis caused by 
these drugs is usually attributed, but this does not 
seem to be a wholly satisfactory explanation in 
every case. Since phenacetin is decomposed more 
slowly than acetanilid, it is not so active, but it is 
safer and the action is more prolonged. Anti- 
pyrin is not decomposed in the body, but is ex- 
creted in the urine unchanged. 

It is decidedly preferable for the practitioner to 
study the action of one or two of these agents 
while accurately observing the effects on his pa- 
tients, rather than experiment with a large num- 
ber of them. 

While large doses of these antipyretics are usual- 
ly borne very well, it should be remembered that 
many people present a peculiar idiosyncrasy and 
even ordinary doses may cause cyanosis and alarm- 
ing collapse, while the heart becomes extremely 
weak and even death may result, particularly in 
febrile patients. Even the same patient may react 
quite differently at different times toward the 
same antipyretic. 

The official salicvlic acid, discovered in 1839, 



ANALGESICS AXD SOPORIFICS. 311 

was introduced as an antiseptic in 1873 and later 
as an antipyretic. The salicylates now find their 
greatest usefulness in the treatment of acute rheu- 
matism. They have been discussed in connection 

with internal antiseptics. 

CHEMISTRY OF THESE PREPARATIONS. 

A brief review of the chemistry of the antipy- 
retic group will show the relationship of the 
various memljers to each other. 

Quiuin Ijcing a derivative of quinolin, many at- 
tempts were made to produce it synthetically, with 
the resulting discovery of a number of quinolin 
derivatives which possess antipyretic properties, 
but all of them dangerous because of their ten- 
dency to produce collapse. All of these are now 
practically obsolete. 

Another substance having antipyretic action is 
phenylhydrazin, which is of interest because of its 
derivative, antipyrin. Hydraziu. N^H^ (or 
HoN — XH,), which is formed by the union of 
hydroxylamin and ammonia, usually exists in com- 
bination with an organic radical. 

Slarliiiii- with tlie bonzune ring CrH,., 





H 
C 

HC CH 




HC in 




c 

H 




benzene 


phenol (c;nli( 


ilic iicid ) is foiiiiod by replacing an 


H with on. 


if this (.)11 in turn be displaced by 



312 I'HAh'MACOl'EIA AND PHYt^ICIAN. 

the hydraziii radical, phenyl hydrazin is formed 
thus : 

C[OH HjHN-NHj CH3N.2+H.O 

BC \aI HC CH 

11+ =11 

HC CH HO CH 



C C 

H H 

phenol+hydraziii= phenyl-hydrazin+ water. 

Though many derivatives of phenyl-hydrazin 
have been exploited, antipyrin and its compounds 
are the only ones in general use. 

When the practitioner uses drugs which at best 
are so potent for harm he will do well to employ 
them in their simplest form rather than in such 
unofficial combinations as hypnal (chloral and an- 
tipvrin) or salipyrin (salicylic acid and antip}-- 
rin). 

Acetanilid or phenyl-acet-amid is obtained by 
the action of boiling glacial acetic acid on anilin. 
By introducing "acet" before "amid" the chemic 
name is derived. 

CNH[H+HO]OC.CH:i CNH.OC.CHa+H.O 
/ \ / \ 

HC CH HC CH 

~ HC CH 



iu = -1 i- 



c c 

H H 

Anilin+acetic acid — acetanilid +water 

When other acid radicals replace that of acetic 
acid similar compounds are formed, which are in 
no wise superior to the official. Thus we have benz- 
anilid and exalgin (or methyl acetanilid), the lat- 
ter differing from acetanilid only in having a CH3 
group replacing an H. 

It will be understood from its chemistry why 
acetanilid can be prepared so cheaply and, there- 



AXALGE.'^ICS AXD SOPORIFICS. 313 

fore, why it is so extensively employed in the nos- 
trum traffic. 

Phenetidin is important as the basis of the phen- 
acetin group. Chemically it is the ethyl ester 
(sulphuric, so called) of amido-phenol. We have 
par-amido-phenol, and if the OH is then replaced 
by the ethyl radical we have phenetidin. 



HC CH HC CH 

II II 

HC CH CH CH 

\ / \ / 

C C 

H NHo 

Phenol Par-amido-phenol 

Various acid radicals may replace an li of the 
NH,. If it be the acetic radical we have phenace- 
tin, if lactic aeid we have lactophenin. 

These formulas may appear complex, but a care- 
ful examination of them will show the relationship 
existing between the various members of the group. 
If the practitioner finds the official phenacetin un- 
suitcd to his purpose in a given case, it is not 
probable that another compound, differing merely 
in the nature of an aeid radical, will prove more 
beneficial. 

Among the' phenetidin series there are, besides 
the official phenacetin, many in which the syllable 
"phen" indicates the phenetidin source. They in- 
clude phenocoll, salophen, lactophenin and many 
others. 

'Wo .shall liave occasion In mciiiioii in'ctlianc^ 
(ethyl c;ii-li;iinalr) ;iin,.nu- ||ic li vd I'nlcd .■liloral 
groii|i, mid il may lie said llial several of its deriv- 
aliv.'S have Keen \\>i'>\ as aid i|iyrel ics. I. ill (hey 
do iiol merit riiillier coiisideral ion here. 



.'514 PHARMACOPEIA AND PHYSICIAN. 

In connection with the subject of antipyretics 
we ma}' mention a number of substances which, 
except historically, are now of little interest. 
Kairiri, discovered by Dr. 0. Fisher in 1882, was 
the first of the coal-tar compounds to be introduced 
as an antipyretic on the strength of physiologic 
experiments. It was also one of the first of the 
medicinal synthetic chemicals to be patented. The 
older physicians may remember its widespread 
use and some of the exaggerated claims that were 
made for it and how, despite this, it fell into dis- 
favor and was soon forgotten. 

Thallin, made by Dr. Skraup in 1884 and inves- 
tigated in the clinic of ISTothnagel, soon shared the 
fate of kairin, despite liberal advertising. 

The enormous growth of the traffic in proprie- 
tary remedies mainly composed of acetanilid and 
allied substances was probably the most potent fac- 
tor in arousing physicians to a realization of the 
part they play — often unconsciously — in further- 
ing the selfish schemes of unprincipled manufac- 
turers. The Council on Pharmacy and Chemistry 
of the American Medical Association has shown 
that antikamnia, phenalgin, salacetin and am- 
monol were mere mixtures of acetanilid with other 
substances, and the federal pure food and drugs 
law has demonstra-ted that some of them, at least, 
have been changed in composition and now contain 
phenacetin. 

We can, therefore, no longer prescribe these mix- 
tures under the impression that we are using true 
chemical compounds. It is probable that acetanilid 
figures more extensively in self-drugging than does 
any other single substance. 



ANALGESICS AXD SOPORIFICS. 315 

The following are official : 

AcETAXiLiDUM. — U. S. P. — Acetaiiilitl, antifeb- 
rin or phenylaeetamicl, the monacet}'! deriyative of 
anilin, occurs in colorless crystalline laminse or 
powder, permanent in air, odorless, of a slightly 
burning taste, and very slightly soluble in water. 

It was first prepared by Gerhard in 1852, but 
was not used medicinally until nearly thirty years 
later, when it was introduced under the trade- 
mark name of autifebrin. It is now employed 
very extensively, its extreme cheapness^ — less than 
2 cents an ounce — causing it to be used as the basis 
of many pretended synthetics. 

Average dose: 0.20 gm. (3 grains). 

PULVIS ACETAXILIDI COMPOSITUS. — U. S. P. - 

This has been made official to serve as a substitute 

of uniform standard for the host of more or les? 

similar compounds, such as we have enumerated 

above, wliieli have come into such unfortunate 

vogue. 

The official preparation consists of 70 per cent. 

of acetanilid. 10 per cent, of caffein and 20 per 

cent, of sodium bicarbonate. 

Average dose: 0.3 gm. (5 grains)." 
AcKTPiiEXETiDiNUM. — U. S. P. — iVcetphencti- 

din, jjctter known as phenacetin, is official in the 

5. It should be noticed that the dose of acetanilid in the 
mixture is larger than the official dose of acetanilid ; yet 
it Is supposed to act more effectively when mixed with so- 
(Ihiin bicarboiiale. It is to be regretted tliat such a combi- 
nation lias been given ofBcial recognition. The reason, of 
course, is evident — persistent advertising of certain nostrums 
has created an abnormal demand' for acetanilid combined 
with a supposed heart stimulant. IJiit, as it is extremely 
liiiprr)l)al)le that calTeln does countenicl the liiiiinin! i-UVcts of 
airtaiillld, it Is not wise to recogni/.r sinli a i cniblnation 
I'VfU III meet a suppr)sed demand. 



31 G PHARMACOPEIA AND PHYSICIAN. 

British, German and other European pharmaco- 
peias as Phenacetinum. It is officially described as 
Acet-para-phenetidin, a phenol derivative, the 
product of the acetylization of par-amido-phene- 
tol. Phenacetin occurs as white glistening scales 
or a fine crystalline powder, odorless and nearly 
tasteless. It is soluble in 925 parts of water and 
in 12 parts of alcohol. 

Average dose: 0.5 gm. (8 grains). 

Antipyrina. — U. S. P. — Antipyrin is official in 
France as Analgesin, in Great Britain as Phena- 
zonum, and in Germany as Pyrazolonum — phenyl- 
dimethylicum. Chemically, it is described as 
phenyl-dimethyl-pyrazolon, and is obtained by the 
condensation of phenyl-hydrazin Avith aceto-acctic 
acid and subsequent methylation of the product. 
Antipyrin occurs as a colorless, almost odorless, 
bitter tasting, crystalline powder, that is readilji 
soluble in water and soluble in about 1 part of 
alcohol. 

Average dose: 0.250 gm. (4 grains). 

Antipyrin was. first prepared by Dr. L. Knorr of 
Erlangen, in 1884; it was investigated physiologic- 
ally by Professor Filehne, who reported it as an 
active antipyretic. 

It will be more satisfactory to consider the 
therapeutics of these antipyretics collectively, with 
occasional comments on the separate meml)ers of 
the group. 

They are mostly used for headache and for the 
reduction of temperature in fevers of an intermit- 
tent type, Ijut it must not be forgotten that they 
do not remove the underlying cause, and that the 



ANALGESICS AXD SOPORIFICS. 317 

use of these drugs in continued fevers is liable to 
be harmful, since the temperature is sure to return 
to its former height, or to go even higher, when the 
action of the antipyretic has worn off. 

The alarming collapse that may follow even a 
moderate dose of acetanilid serves as a warning 
against its use when there is reason to suspect any 
tendency to that condition. On the other hand, a 
sudden lowering of the temperature in fever may 
result in collapse symptoms wholly independently 
of the nature of the remedy employed. Acetanilid 
has the greatest and phenacetin the least tendency 
to produce collapse among the official preparations 
of this nature. It is. in part, to overcome this 
tendency that caffein is used in the official com- 
pound acetanilid powder, but it is doubtful if it is 
of any great value in guarding against this col- 
lapse, though it does appear to enhance the anal- 
gesic action of this class of remedies. There can 
be little doubt that many of the sudden deaths, of 
which we so constantly read, occurring without ap- 
parent cause on the streets and elsewhere, are in 
reality due to overdosing with nostrums containing 
acetanilid. 

Women should ho pai'ticuhirly faulioncd against 
the })romiscuous use of nostrums of the compound 
acetanilid powder type during menstruation. 

When it is reinemhi'i'cd that antipyrin and ace- 
liiiiilid are derivctl IVom phenylhydrazin, and 
aiiiliii — :i(li\c l)hi(ti| poisons — it is not surprising 
that the ollicial (h'i'i val ivcs ])0ssess the ]iropor(ics 
of these drugs in a niiiior (h'Lii'i'o. 

The collaj)sc .-ecu nfici' inguslion of the anti- 



318 PHARMACOPEIA AXD PHYSICIAN. 

pyretics, particiilarh' acetanilicl (least with phen- 
acetin), is due to several causes. Probably the most 
frequent cause is the mere lowering of the temper- 
ature which exposes the collapse actually existing 
but hidden by tlic high temperature. This result 
is not to lie charged to the antipyretic. It is 
treated exactly as collapse from any other cause 
Avould be — by stimulation. Very large doses of the 
antipyretics act on the heart muscle, causing de- 
pression, and on the vasomotor center, causing col- 
lapse. 

The acetanilid hal)it is not rare and it leads to a 
deplorable condition, but the symptoms generally 
disappear when the drug is withdrawn. 

Profuse perspiration is a disagreeable effect, 
more frequently seen after acetanilid and anti- 
pyrin than after phenacetin. If this is so annoy- 
ing as to demand interference, a hypodermic in- 
jection of 0.5 mg. (1/120 grain) of atropin will 
be found effective. Eedness and irritation of the 
skin are frequently seen after the use of the various 
antipyretics of this group. They are probably due 
to vasomotor changes. 

Antipyrin in solution has been used extensively 
to check the bleeding of superficial wounds, and all 
the various members of tliis group are to some ex- 
tent antiseptic. 

While so much space has been devoted to the 
contraindications and untoward effects of these 
agents, it is not with a view of discouraging their 
use, but rather that the physician may avoid the 
disappointments which arise from their use in im- 
favorable conditions. 



ANALGESICS AND SOPORIFICS. 319 

Acetanilid ma}- be o:iven alone in powder or in 
capsules, in adjuvant or aromatic elixir, or sus- 
pended in syrup or mucilage of acacia. The com- 
pound acetanilid powder affords a convenient form 
for the relief of headache. A dose of 0.3 gm. (5 
grains) in powder or capsule is usually effective; 
this may be repeated once in an hour if necessary, 
but further repetition is to be avoided. 

Compressed tablets of such insoluble substances 
as phenacetin and acetanilid are not recommended 
as they disintegrate slowly. 

An acetanilid powder, containing ammonium 
carbonate instead of caffein, is used in the German 
Hospital of Philadelphia,*' when it is desired to 
avoid tlie cerebral stimulation of caffein. 

Antipyrin is very soluble in water and in alco- 
hol, and hence it may be given in simple aqueous 
solution, in aromatic elixir or in powdered form, 
but not in combination with other active remedies, 
as it is readily decomposed. 

Acetphenctidinuin (phenacetin), being less ob- 
jectional)U' than acetanilid and antipyrin, may be 
expected to replace them very largely now that the 
price is reduced. Its insolubility in water has led 
to its extensive use in powder and in capsules. 

A combination of phenacetin. calTein and sodium 

0. 
R. A<etanllldl | 

Sodii bicarli.. fifi grs. xxii 1 .". 

Aininon. call) grs. xi |7."> 

'I'hls Is siillicii'iil for ti'n powders of about 0.3 gm. (."» 
grains) cacli. one l)i'iiig givoii every threo or four hours to 
r(?duc(' fi'vrr. For licadaihc one is given niul repeale^l, if 
necessary, in an hour. 



a20 PHARMACOPEIA AND PHYSICIAN. 

bromid has attained considerable popularity; these 
may be combined in various ways." 

The antipyretic action of these drugs is obtained 
best by administering them when a natural remis- 
sion of the fever begins. 

Acetanilid causes a more prompt fall of the tem- 
perature, while the action of phenacetin is more 
lasting. 

Small doses are usually effective in typhoid 
fever, but even large amounts are often ineffective 
in pneumonia and septic conditions. 

The relative value of the antipyretics of this 
class and the cold bath is still the subject of dis- 
pute, and circumstances must determine which is 
to be used in any case. In districts where trained 
attendants are not to be had the careful use of the 
antipyretics is certainly preferable to the cold bath 
given by inexperienced nurses, or by indifferent 
orderlies, as is the custom in some of the large 
hospitals in New York, for example. 



R. Acetphenetidini (phenacetin) ...grs. xy 11 

CaffeiuiE grs. via o 

Sodii bi-omidi ■■?.] ^ 4 

Elixir adjuvantis iSm 1UU| 

The mixture is to be shaken and two teaspoonfuls givenas 
a dose. This is often used for headache, one dose being 
usually sufficient. . . . 

Still another, widely used, mixture containing acetanilid, is 
a migraine elixir that is being exploited by a number of 
manufacturers. A representative formula, for a preparation 
of this kind, may be given as follows : 

R. Acetanilidi S^'- ^^^. 

Caffeinse S^.u] 

Sodii bromidi ^l\ 

Alcoholis • f3i , ^4 

Elixir aromatici q. s. tt tjiu 100 

Average dose .5 c.c, or 1 teaspoonful. 

If 20 c. c of tincture of cardamom be added to this, or 
if adjiivant elixir (which is also official) be used instead 
of the aromatic, the appearance of the mixture will be 
much enhanced and the psychical effect increased. 



ANALGESICS AND SOPORIFICS. 321 

THE HYDRATED CHLORAL GROUP. 

The hydrated chloral group includes, besides h\- 
drated chloral, chloralformamid (chloralamid), 
paraldehyd, ethyl carbamate (urethane), sulphon- 
methane (sulphonal) and suljjhonethylmethane 
(trional). Several of these preparations are so 
well known that we may dismiss them in a few 
words, but some of them may 1)0 profitably dis- 
cussed at greater length. 

It was formerly supposed that hydrated chloral 
was decomposed in the body Avith the formation of 
chloroform, on which the action of the drug de- 
pended. This is now known to be incorrect, for 
the drug is excreted in the urine, for the most 
part, as trichlorethyl glycuronic acid. 

Hydrated chloral acts very much like chloro- 
form on the heart and on the central nervous sys- 
tem. Small doses act only on the brain, resulting 
in a lessened mental activity and a diminished 
receptivity of impressions, thus inducing sleep. 
The pulse and respiration become slower as in nor- 
mal sleep. With larger doses there is a depression 
of the spinal reflexes and of the respiratory and 
vasomotor centers, the heart is slowed by direct 
action, as after chloroform. The cutaneous ves- 
sels are markedly dilated, and this may cause fall 
of temperature and sometimes a skin rash. 

Death follows large doses, from paralysis of the 
heart as with chloroform, and the respiration may 
be paralyzed at the same time. 

''I'he same degenerations are seen after hydrated 
cliliiral as al'dT fiilorofdnii. and the contraindica- 
lions for the two drugs arc the same, degcncra- 



322 PHARMACOPEIA AND PHYSICIAN. 

tion of tlie heart and vessels, nephritis, gastritis, 
and depression of tlie respiratory center. 

Hydrated chloral acts as a ruljefacient when ap- 
plied locally, and this irritant action is manifested 
in the stomach Avhen taken in concentrated solu- 
tion. It should, therefore, be given well diluted, 
and large closes are apt to cause gastric irritation 
even when this precaution is observed. 

The same train of symptoms which characterize 
chronic alcoholism are seen when hydrated chloral 
is taken for a prolonged period. 

Sulphonal is excreted more slowly than it is ab- 
sorbed, and cumulation may occur. It is contra- 
indicated in nephritis. 

It is easy to drug anyone into unconsciousness, 
but the members of this group do not possess cura- 
tive properties and at most they only secure rest 
and sleep for the patient. Hydrated chloral is not 
free from danger, and we wish to point out some 
of the dangers attending its use, either alone or in 
the nostrums whicli contain it. or closely related 
substances.^ 

All authorities agree that it is unjustifiable to 
use large doses of hydrated chloral, either alone or 
in combination with other official drugs. When a 
moderate dose of hydrated chloral fails to induce 

8. Attention has been called to Bromidia, which is di- 
rected to be given in as much as teaspoonful doses every 
hour until sleep is produced, pain being mentioned as one 
of the indications for its use. Since hydrated chloral is not 
an anesthetic, except in unsafe doses, it is readily seen how 
dangerous this advice Is. particularly when we are dealing 
with such intense pain as that encountered in appendicitis, 
even admitting that the preparation contains the other in- 
gredients claimed. 

It will be noticed that the dose of hydrated chloral given 
here is only about 7 grains (0.5 gm.), but combined with 
sodium bromid is effective and quite safe. 



AyALOESICS Ayo >'<UI'(JIUFICS. 323 

sleep in cases of severe pain, it is very much more 
rational to give a dose of morphin, or other anal- 
gesic, than to repeat the hydrated chloral indefi- 
nitely. The hydrated chloral habit is not rare, and 
if its sale at cut rates in the shape of nostrums 
with fanciful names is to go on unchecked, we can 
hardly hope to see any diminution of the baneful 
practice. When we employ hydrated chloral and 
sodium, or potassium bromid in simple solution it 
is with full cognizance of the danger, but because 
the exigencies of the case demand their use, and we 
only use them with caution.'' In a general wav the 
contraindications for hydrated chloral are the same 
as for chloroform. In the present addition of the 
Pharmacopeia it is official as : 

CiiLoiuLUM Hydhatum. — U. S. P. — Hydrated 
Chloral. 

Average dose: 1 gm. (15 grains). 

Of the unofficial, more or less closely related 
drugs, bypnal (antipyrin and hydrated chloral) 
has been mentioned. 

Somnos is a 5 per cent, solution of eliloral gly- 
cerolate, also known as trichlorethidene propenyl 
ether. Its action is identical with that of a 5 
per cent, solution of liydrated chloral in a similar 
vehicle; isopral is triclilorisoprop^d alcohol; its 

0. A fairly safe anrt vory efBcient hypnotic commonly used 
in IJclleviio Hospital in N'ow York affords a convenient form 
of iisinfr sodium linnnid with hydrated chloral. 

R. f'lilorali liydrali grs. xx ll.-^n 

Sodii liroiiiidi prs. Ixxx ."•;{(» 

Syr. aui-antii f3iv Ki'l 

Aqua; q. s. ad toi :'>()| 

Two teaspoonfuls arc >;iven at a dose. Tiiis may he twice 
repeated at Intervals of an liour if necessary, but more than 
two doses are rarely re(|ulred in suitable cases. 

'I'lie hydrated chloral may be slightly increased in the pre- 
scription, in which case the dose should not bo repeated more 
tlian once. 



324 PHARMACOPEIA A.A^Z) PHYSICIAN. 

action is the same as that of hydrated cldoral, but 
isopral is more active and more toxic. 

Dormiol is a combination of amylene hydrate 
and liydrated chloral, and chloralose. a combina- 
tion of hydrated chloral and glucose, partakes of 
the action of morphin and is rather expensive. 
Chloretone. another of the more recent products. 
is not entirely devoid of danger and is not always 
so certain in its action as hydrated chloral, while 
butyl chloral hydrate or croton chloral hydrate, is 
one of the older compounds that has been found 
wanting and is now little used. Of the official 
compounds of this group we have : 

Chloealformamidum. — U. S. P. — Chloralfor- 
maraid. Chloralamid. This has practically the 
same action as therapeutic doses of hydrated 
chloral, the latter being formed in the body by de- 
composition of chloralformamid. 

Average dose: 1 gm. (15 grains). 

Paraldehydum. — U. S. P.— Paraldehyd, a 
transparent liquid, is slower in its action than hy- 
drated chloral, but also safer. It has the disad- 
vantage of a persistently disagreeable taste and 
odor. It is locally irritant and should not be used 
in irritable conditions of the stomach. It may be 
prescribed dissolved in 10 parts of water or in 
aromatic elixir, and is l)est administered cold, or 
followed by a cold drink. 

Average dose: 2 c.c. (30 minims). 

SuLPHONMETHANUM. — IJ. S. P. — Sulphonmeth- 
ane, sulphonal, diethylsulphonedimethylmethane, 
and 

SULPHONETIIYLMETHANUM. — U. S. P. — Sul- 

phonethylmethane, trional, disulplionmethylethyl- 



I 



AyALGEiilOi AND SOPORIFICS. 325 

methane, ma}' be considered together, as the}^ differ 
chemically only in the addition of an ethyl group 
in the latter. 

Average dose (either) : 1 gm. (15 grains). 

The therapeutic action of these two preparation.s 
is practically identical, and the closely related 
tetronal might also be included in this statement. 
Trional is somewhat more soluble than sulphonal. 
While these substances are safer than hydrated 
chloral they are not wholly free from danger, as 
fatal cases of poisoning have been reported and the 
sulphonal and trional habits, while of more recent 
origin, bid fair to equal, if not to exceed, the chlo- 
ral habit in the number of their victims. These 
agents are usually given in powder, and owing to 
their slow absorption should be given about two 
hours before they are expected to act. To insure 
more speedy action they may be given in solution, 
for which purpose they can be dissolved, or at least 
suspended, in a cup of hot milk. 

^Etiiylis Carbamas. — U. S. P. — Ethyl Car- 
l)amate, urethane. This is a new official prepara- 
tion whicli is chiimed to be much safer than hy- 
drated chloral, to which it would be distinctly su- 
perior l)ut for the fact that its action is n8t so cer- 
tain and because tolerance is soon acquired. It is 
Ijest given in water, in which it is very soluble. 
The average dose is 1 gm-. (15 grains). 

The therapeutic use of this group of agents is 
indicated by the term soporific, and by what has 
been said concerning their pharmacology. 

THE BROMID GROUP. 

"IMic bi'omids depress the central nervous system 
- Iiiiiiii. iiirduUa and cord — siniullaiK.'ousI v. 'I'be 



326 PHARMACOPEIA AND PHYtiWIAN. 

action on the psychic centers results in mental con- 
fusion and impaired memory, the action on the 
medulla and cord in diminished reflexes. This is 
especially noticeable in the lessened reflex from 
the throat, and the bromids were used before the 
introduction of cocain in examination of the 
lar3^nx. This also explains the lessened sexual 
desire, and the depression of the motor and sen- 
sory cells explains the value of these agents in 
epilepsy. 

Long continued use of the bromids leads to the 
condition known as bromism, the most prominent 
symptoms of which are the skin eruptions of dif- 
ferent kinds, the fetid breath, coryza, nausea and 
vomiting. 

The mental depression results in a tendency to 
sleep, but this is not so restful as that following 
hydrated chloral, and the patient usually experi- 
ences some dulness and mental confusion for some 
time after awakening. Large doses of potassium 
bromid depress the heart, but this action is mainly 
due to the potassium ion, and it does not occur 
after the use of the other alkaline bromids. 

Owing to their depression of the cord the bro- 
mids are antagonistic to strychnin. 

The excretion of the bromids begins very soon 
after they are taken, but a long time elapses be- 
fore they are completely eliminated. 

Monobromated camphor has no such action as 
that of the alkaline bromids, because the bromin 
ion is not dissociated. It belongs to the camphor 
group, and, having no advantage over camphor, 
it should be dismissed from the Pharmacopeia. 

The bromids are of considerable historic, as well 



ANALGESICS AND SOPORIFICS. 327 

as of practical, interest. Potassium bromid was 
introduced by Balard about 1826, who supposed it 
to have properties analogous to those of potassium 
iodid. It was not until some time after 1850 that 
the present, sedative, uses of the bromids were ac- 
cidentally discovered. During the past four dec- 
ades the several alkaline bromids have received con- 
siderable attention, and several of them are now 
oflficial in every pharmacopeia. 

The abuses that have arisen in connection with 
substances belonging to this group are largely due 
to the misrepresentations that are made in connec- 
tion with the efficiency or the character of the 
nostrums containing them. 

Strontium salts, particularly the bromid, were 
brought forward some years since, at exorbitant 
prices, as being infinitely superior to the corre- 
sponding compounds of other elements. Experi- 
ence has shown that, in the main, these claims were 
unfounded, though many, even now, claim that 
strontium bromid disturbs the stomach less than 
the corresponding sodium or potassium salt. An- 
other claim that is frequently made by manufac- 
turers of nostrums like "Peacock's Bromides," is 
that they use "chemically pure" salts. Exactly 
what is meant by this claim it is difficult to say, 
but tlie Pharmaco])eia gives us a number of readily 
applied tests by which the salts themselves may be 
tested. 'Flic niJiiiiiraciiirci's of nostrums, on tlie 
other hand, nol in ri'('(ni('n(ly add the vei'v sul)- 
staiiocs tliat are considered contaminations. 

'J'hc official bromids are freely polnl)l(> in waicr. 
and they are best directed to be d is [k used in 
aqueous solution, with or witliouL the addition 



328 PHARMACOPEIA AND PHYSICIAN. 

of some one of the aromatic sj^rups. The avail- 
able salts are : 

x\mmonii Bromidum. — U. S. P. 

Calcii Bromidum. — U. S. P. 

LiTHii Bromidum. — U. S. P. 

PoTASsii Bromidum. — U. S. P. 

SoDii Bromidum. — U. S. P. 

Strontii Bromidum. — U. S. P. 

Average dose (of anj- one of these) : 1 gm. (15 
grains). 

AciDUM Hydrobromicum Dilutum. — U. S. P. 
— Diluted Hydrobromic Acid contains 10 per cent, 
of absolute hydrobromic acid. 

Average dose: 4 c.c. (1 fluidram). 

The bromids are useful in the treatment of epi- 
lepsy, for, while a cure is very rarely effected, they 
lessen the frequency of the attacks in a very large 
proportion of the cases. Potassium bromid is 
usually preferred, but some use a mixture of the 
alkaline bromids. No perceptible effect may be 
seen for some time after the commencement of the 
treatment, but with persistence the benefits usually 
follow. In such cases the skin eruptions may prove 
very annoying; scrupulous cleanliness should be 
enjoined, and arsenic may prove useful for the 
acne. 

The bromids are very useful in sleeplessness 
caused by mental worry, but they are ineffective 
when it is due to pain. 

Bromism increases the patient's susceptibility to 
contagious diseases, such as pneumonia and bron- 
chitis. 

Hydrated chloral acts as a soporific in smaller 



AXALGE^<ICS A\D SOPORIFICS. 329 

doses when a bromid is added, and they may be 
prescribed somewhat as follows : 

R. Potass, broni 3iss 6| 

Aquae f§i 30| 

Aquae menth. pip., q. s. ad fgiii 100| 

Misce. Sig. : A tablespoonful at a dose. 

Of conrse. any of the alkaline bromids may be 
nsed in place of the potassium bromid, but the 
latter is much the most frequently employed and 
appears to be the most effective. 

The N". F. elixirs of the bromids of ammonium, 
sodium, potassium and of lithium may be used, 
but they should be diluted with severiil times as 
much water. The routine use of alcoholic liquids, 
such as these elixirs, is not recommended in those 
cases where the drug in increasing doses is likely 
to be continued for some time. 

As in the case of other salts, the bromids arc 
irritant to the stomach and should be given well 
diluted witli water — never in the form of com- 
pressed tahlcts — and best after eating. 



CHAPTER XIV. 

CIRCULATORY STIMULANTS. 

The subject of circulatory changes is entirely 
too extensive for anything like a comprehensive 
treatment in tlie limited space that can be allotted 
to it here, but we shall discuss some of the indica- 
tions for influencing these changes and try to 
indicate how they may be brought about. 

The term "heart tonic" has been so loosely em- 
ployed that it is better to avoid it altogether, or 
to use it only with reference to those drugs which, 
acting directly on the heart, improve the muscular 
tone. 

The heart is but one, and in some respects even 
a minor, factor in the question of blood pressure, 
on which the state of the circulation largely de- 
pends. Hence, while a "heart tonic" implies an 
agent which improves the action of the myocar- 
dium, the actual changes in the circulation depend 
not alone on the amount of work done by the cen- 
tral organ, but on the combination of that and the 
constriction or dilatation of the blood vessels. 

Since the relative amounts of blood existing in 
the veins and arteries, and the amount which 
passes through a certain area or organ in a given 
time are dependent on several more or less closely 
related factors, we may direct our efforts toward 
influencing one or more of these factors when we 
wish to increase or diminish the blood supply of 



CIRCULATORY STIMULAXT8. 331 

an organ, or -when we wish to hasten the transfer 
of blood from veins to arteries. 

An increase in the rate of the heart or strength 
of the beat, without a compensating change, either 
in the heart itself or in the blood vessels, will, of 
course, increase the general circulation, and con- 
versely, a diminished action would lessen the cir- 
culation, but so delicately is the complex circula- 
tory mechanism adjusted that such a simple 
change pro]jal)ly never occurs alone in the intact 
body, thougli it may at times predominate over 
other accompanying changes. 

THE MECIIAXIS:\[ OF STi:\I ULATIOX. 

The simplest means of increasing the blood pres- 
sure, consists in increasing the strength of the in- 
dividual beats when they are too weak (whereby 
the heart is more completely and more forcibly 
emptied), and securing just enough slowing to 
enable the heart to dilate more fully and to become 
filled with a larger volume of blood. These two 
actions insure a larger volume of blood being 
thrown into the aorta in a given length of time 
tban occurred under previous conditions. An in- 
creased vohime of blood with increased force must, 
of course, insure an increased circulation in those 
areas in wliicli tlici-c is 710 great cliaiigc in the 
caliber of tin' siiialler vessels. 

A lii,!jli Mood pressure, on the other liaiid, inny 
l>e most simply reduced by slowing the lienii witli- 
oiil increasing its stivngtb, or by acting on llie 
\-essels |)ei-i|)l)erally or through the vasomoloi' cen- 
lers. eaiisiiiL;' dilation. 

'j'he aeeiimnlalioii of an limine amount of l>lood 



332 PHARMACOPEIA AKD PHYSICIAN. 

in the veins is relieved by increasing the efficienc}^ 
of the heart as mentioned for raising the blood 
pressure — by slowing and strengthening its beat — 
for, as we have seen, this improves the drainage 
from the veins by lengthening the diastole, while 
the strengthening throws a larger volume of blood 
into the arteries. 

We uiay arrange the agents affecting circulation 
into two groups as follows : Those mainly affect- 
ing the heart, directly or indirectly; those mainly 
affecting the vessels, directly or indirectly. 

The most important group of circulatory stim- 
ulants consists of digitalis and a number of sim- 
ilarly acting substances. While, as is well known, 
barium chlorid has an action to some extent simi- 
lar to that of digitalis, nearly all the other mem- 
bers of this group that are of therapeutic impor- 
tance are somewhat allied chemically; for the 
most part the active principles of these drugs are 
glucosids or resins. The exact chemistry of the 
drugs of this class is still obscure, despite numer- 
ous investigations, and it demands but little con- 
sideration here; their pharmacologic action, how- 
ever, serves to explain their therapeutic indica- 
tions, and may aid in choosing the one l)est suited 
to a given condition. 

The circulatory conditions demanding stimula- 
tion are mainly those in which undue relaxation 
occurs, and in which an imperfectly acting heart, 
including such conditions as valvular insufficiency 
and stenosis, permits the blood to accumulate in 
the veins. Any increase in the work of the heart 
must tend to relieve, these conditions, particularly 
if there is at the same time just sufficient slowing 



CIRCULATORY STIMULAXT8. SXi 

to secure eoiuplete distention of the heart with 
blood during diastole. 

An increase in the strength of the contraction 
more coni2)letely squeezes the venous blood out of 
tbe heart muscle, which is then supplied with a 
larger j^roportion of arterial blood. The increased 
force of the jjulse wave must first be felt more 
strongly in the coronary artery than elsewhere, 
since there is less inertia to be overcome in the 
much shorter column of blood between the aortic 
valve and the opening into the coronary artery. 
The longer diastole then j)ermits a more perfect 
supply to the capillaries in the heart, thus improv- 
ing the nutrition of the heart to an even greater 
degree than would correspond to the extra work 
thrown on the ventricles by their being compelled 
to contract against an increased arterial pressure. 

As we have just said, the slowing of the heart. 
should be just sufficient to enable the heart to be- 
come fully distended, for a greatly slowed heart 
would suffer in lessened nutrition, because, other 
tbings being equal, the rate of flow through the 
coronary circulation varies with the number of the 
])uisations in a given space of time. 

'I'liis improved nutrition of the m3'ocardium is 
llic lirst essential for a sustained increase in the 
force of the beats, cither from a more energetic ac- 
tion of the uiuiltci'cd licart or after hy))ortrop]iy ; 
because, ho\\r\ci-. siidi a iiiiisclc mi^iht he stimu- 
hited to unusual a(li\ity. cNliaustiou and paralysis 
must follow unless nulrilioii keeps pace with llie 
work j)erfonne(l. Langendoi-JV lias shown experi- 
iMcntally that the energy of the lieait is enor- 
mously influenced by the available blood supply. 



334 PHARMACOPEIA AND PHYSICIAN. 

A drug might affect one or more phases of the 
heart beat, or the local and central action may be 
in part antagonistic and the effect on the blood 
pressure in the general circulation will in the lat- 
ter case be dependent on the kinds of influence 
and the degree to which each is excited. 

Slight slowing with increased strength of con- 
traction may improve the nutrition, and it will be 
readily" understood why it is difficult to secure 
equally perfect nutrition of the heart when it is 
made to beat more rapidl}', since the only factor 
here which makes for an improved coronary circu- 
lation is the more frequent squeezing out of venous 
blood by the contractions while all other conditions 
are unfavorable, a greater number of contractions, 
each throwing out less blood and meaning more 
energy expended for a given amount of work per- 
formed — a more frequenf overcoming of the iner- 
tia of the blood in the arteries — so that a very 
rapid heart soon exhausts itself. For these reasons 
we do not often seek to raise blood pressure or to 
improve the general circulation by increasing the 
rate of the heart unless it is extremely slow. 

Shock and collapse are conditions that are due 
to depression of the respiratory, cardiac and vaso- 
motor centers. The depression of the vasomotor 
center permits the vessels to dilate and the blood 
gravitates to the vessels of the splanchnic area, 
which are capable of holding a very large amount. 
This dilatation is accompanied by a fall of pres- 
sure in the general circulation, less blood goes to 
the centers and to the coronary circulation, the 
heart beats more feebly and the respiration be- 
comes weaker. This condition obviouslv calls for 



CIRCULATORY STlMlLiyTti. 335 

prompt stimulation of the circulation. It is ap- 
parent, however, that a stimulation of the heart 
alone would only result in increased work while 
its own nutrition would not he correspondingly 
improved hccause the pressure in the coronary cir- 
culation can not be greatly increased so long as the 
voluminous vessels of the splanchnic area offer 
cavernous spaces for the blood which is pumped 
from the heart. 

Stimulation of the constrictor mechanism of the 
vessels is urgently demanded in collapse, and this 
is secured in the mildest cases l^y gravity deter- 
mining the blood to the head when the head is 
placed lower than the body. The centers are 
toned up by the better blood supply, and this in- 
creased tone of the vasomotor center causes con- 
striction of the splanclinic vessels, raises the blood 
pressure and improves the general circulation, 
which, in turn, further tones up the centers as 
well as the heart, which is also stimulated by the 
improved tone of the cardiac center. The respira- 
tion is improved at the same time owing to the 
improved tone of the respiratory center. 

Dr. George Crile has devised a pneumatic suit 
whereby pressure may be applied to the surface of 
the limbs, thus forcing a large amount of blood 
into the body and head, and gravity (lowering the 
head) may be made to assist in driving it to the 
head — the essential fact Ix'iii.u- (o supply ilic 
iiicdnlhi with blood. 

I'll VSIOLOOIC SALT SOLUTION. 

Hciii, mainly su])i)licd by hot water bottles, 
slioiild lie used widi auv olhcr iiicasiii-os in shook. 



330 rilARMACOPFAA AXD PHYHICIAN. 

The amount of lliiid in the vessels may he consid- 
erahly increased by injecting, under aseptic pre- 
cautions, into a vein, or even under the skin, nor- 
mal saline solution, or, as it is hetter to term it, 
physiologic salt solution, made by dissolving 9 
grams of sodium clilorid in enough water to make 
one liter (approximately 132 grains of sodium 
chlorid to 1 quart of water) . The solution should 
be .boiled (to render it sterile) and then cooled to 
about 40° C. (104° P.). As noted above this 
solution may be used hypodermically or it may be 
injected directly into a vein. Another, and at 
times a very satisfactory, method of attaining the 
same result is to inject slowly one or two liters of 
this solution into the rectum, whence it is readily 
absorbed into the circulation. 

Drugs which act on the vasomotor centers are 
indicated in collapse, but the simple means just 
enumerated serve, as explained, to tone up the 
centers in mild cases by an improved blood sup- 
ply, and they are, of course, preferable to mere 
stimulation by drugs. Then, too, in proportion 
to the urgency of the case is the difficulty of secur- 
ing stimulation of the centers. In profound 
shock the stimulants of the vasomotor centers ap- 
pear to have no lasting effect, or to increase the 
trouble. In collapse of a mild character, however, 
a vaso-constrictor acting more powerfully on the 
vessels of the splanclmic area causes the general 
blood pressure to rise, more blood goes to the cen- 
ters, and they are placed in a better tone, exactly 
as is the case when gravity sends the blood to the 
head. 

Hot alcoholic drinks are very commonly em- 



CIRCULATORY STIMULAXTS. 337 

ployed in collapse and shock; they probalily act 
reflexly from the stomach. 

Some clinicians maintain that morphin im- 
proves a weakened heart. As a depressed center is 
less susceptible to shock from reflex influences, 
morphin may lessen shock or depression due to 
pain, and the centei- will then ])e able to exert a 
better influence on the heart. It has often been 
claimed that opium or morphin caused an in- 
creased supply of Ijlood to the brain by dilating 
the vessels of that organ, and this may account 
for an increased circulation in the cardiac center 
and hence an improvement in the heart. The 
depression of tlie respiratory center by morphin is 
i-ather strong evidence against any stimulation of 
the cardiac center, however. Morphin has no 
direct action on tlic licart and its vasomotor effects 
are variable. 

THE DIGITALIS GROUP. 

The pharmacologic action of digitalis and that 
of its available active ])rinciples have been more 
extensively studied tlian has been done in the case 
of any other member of the group. The isolated 
frog's heart, and latcM- tlio mammalian, has been 
used to determine the iulioii lui i])at organ apart 
from the influence tlirougli the cciitcu-. The rate 
of the isolated uiamiiialiaii heart is citlicr in- 
creased or little afl'ected by digitalis or its pi-iu- 
ciples, but Gottlieb and Magnus found that ilic 
strength of the iiidi\'idiial coulraclioiis is iiicrcasnl 
by it and that iimmv adiial wnvk is done hy tlir 
isolated heart. In llif iidad luaiiiinal digitalis 
slows tlie heai'l liy si iimdai ion of ilio \agiis cen- 
ter, and the slreiigili of the lieat is ineivased hv 



338 PHARMACOPEIA AND PHYSICIAN. 

the action on the myocardium. The vasomotor 
centers are stimulated at the same time. The 
direct results of these several actions have been 
detailed in the introductory paragraphs. 

Digitoxin, the most active of the principles that 
have been isolated from digitalis, has essen- 
tially the same action on the circulatory system as 
the drug itself, but, being insoluble in water, it is 
slow in producing its effects, x^lbert Fraenkel has 
found that about sixty hours elapsed after a single 
effective dose was injected, hypodermically, into a 
cat before the typical action was induced. 

Digitalin, or "Digitalinum verum," is somewhat 
more soluble in water and its action was elicited 
in twenty-four hours after a dose, corresponding 
in activity to that of digitoxin just mentioned, 
was injected into a cat, while strophanthin (ob- 
tained from strophanthus seeds), which is very 
soluble in water, produced its effects much more 
rapidly. The therapeutic action of these three 
substances is very similar, but Gottlieb and Mag- 
nus found that digitoxin is capable of restoring an 
irregularly beating heart to rhythmic pulsations 
to an astonishing degree ; indeed, they were able to 
restore isolated and perfused hearts to strong reg- 
ular beats after they had gone into delirium cordis. 

Digitalis and other members of this group have 
the great disadvantage of causing cumulative ef- 
fects when used continuously for some time. Digi- 
toxin produces these effects more readily than 
strophanthin and digitalin. Fraenkel was able to 
continue the administration of digitalin daily for 
many weeks at near the toxic dose without cumu- 
lative action. No habituation occurred in this 



CIRCULATORY 8TIMULAXTS. 339 

period, however, tlius disproving the claims of 
Heide, based on a much more shorter period of 
experimentation, that such takes place. 

Gastric irritation is the first evidence of a toxic 
action from a single toxic dose or from cumulative 
action, and digitalis, or any of its congeners with- 
out exception, must be stopped for a time when 
cimiulative effects are seen. When the heart is 
slowed by any member of the digitalis group the 
action is very persistent. 

Digitoxin causes constriction of the coronary 
arteries, but this does not occur after strophanthin. 

As noted before, there are other drugs and 
chemicals that possess a somewhat similar action, 
but it must be evident to all that nothing is to be 
gained, and that much harm may result from 
giving heed to unwarranted and exaggerated 
claims of the nostrum maker who lauds a prepara- 
tion which ostensibly depends on some little known 
drug, such, for , instance, as the several species of 
cactus. 

By far the most interesting as well as the most 
important of the official drugs of the group now 
under consideration is : 

Digitalis.^ — U. S. V. — This consists of the 
dried leaves of Dir/Halis purpurea, collected from 

1. From what wo know of liio chemistry of this partic- 
ular druK, and from tho action of tho Itnown isolated proxi- 
mate princiiiies. it would ap^iear that in this connection it 
was particularly unfortunate that the committee on revision 
did not see its way clear to adhere more strictly to the pro- 
posed internal ional standards for the formulas of potent 
medicaments and direct, for Ihe extraction of digitalis, the 
proi)osed 70 i)er cent, alcohol in place of the diluted alcohol 
of the U. S. riiarmacopeia. The strouRer alcohol would 
have had Ihe advantajje of insuring: a more ready and more 
coinplcto solution of the active principles, of answoriiifr hettcr 
as a preservative and of matei'ially reducing llie amount of 
Inert extractive now contained In the ofllcial tincture. 



;U() PHARMACOPEIA AND PHYSICIAN. 

tlic second year's growth at the commencement of 
flowering. This drug is official in all pharmaco- 
peias and is generally considered as being particu- 
larly susceptible to chemical change. It sbould be 
carefully preserved and should not l)e kept for 
more than one year. 

Average dose: 0.05 gm. (1 grain). 

While the chemistry of digitalis is far from be- 
ing thoroughly understood, there are a number 
of proximate principles derived from digitalis that 
are now lacing marketed in a commercial way and 
which have well-defined chemical as well as physio- 
logic properties; several of them are being exten- 
sively used in this country as well as abroad. The 
most potent of these unofficial articles is : 

Digitoxin: This, as has been noted before, is 
soluble in alcohol, but is nearly insoluble in water. 
The older and in some respects better known 
French preparations, variously called digitaline 
crystallisee, or French digitalin, closely resemble 
digitoxin in physical properties and also in physio- 
logic activity. 

Digitalin (Digitalinum verum, Kiliani) : This 
is a white amorphous glucosid that is readily solu- 
l)le in alcohol, but only slightly soluble in water.' 
While it is less toxic than digitoxin and may be 
given in much larger doses, it closely resembles 
that principle in its therapeutic action and uses. 

Digitin (Merck) : This is also readily soluble 
in alcohol and only slightly soluble in water. While 
still available it is now generally thought to be 
physiologically inactive as a circulatory stimu- 
lant. 



CIRCULATORY SriMULAXTS. 341 

Digitalein (Scliiniedeberg) : This is reaclily 
sohible in water and is jirobably a mixture of sev- 
eral proximate principles. 

Digitalin "German" : This occurs as a yellow- 
ish white, amorphous powder that is soluble in 
both water and alcohol. It is said to consist of a 
varial)le mixture of Digitalinum verum (Kiliani), 
digitalein and digitonin. 

The following are official : 

ExTRACTUit Digitalis. — U. S. P. — Tliis is 
made from the fiuidextraet by evaporation. 

Average dose: 0.01 gm. (10 mg. or 1/5 grain). 

Fluidextractuji Digitalis. — IT. S. P. — 
Fiuidextraet of Digitalis is made with dihited 
alcohol. 

Average dose: O.O.") c.c. (1 minim). 

Infusum Digitalis. — U. S. P. — Infusion of 
Digitalis contains I.-") ]X'v cent, of digitalis, 10 per 
cent, of alcohol and L") per cent, of cinuamon 
water. 

Average dose: 8 c.c. (2 fluidrams). 

Tixctura Digitalis. — T'. S. P. — Tliis now rep- 
resents 10 per cent, of the ci-iidc drug in diluted 
alcoliol in ])l;icc (.r l."i pel- cent, as fornici-h- olTi- 
.-ial. 

Average dose: 1 c.c. (lo minims). 

STROlMIAXTIflXU.M. — V. S. I'. — 'i'llis is a ghlco- 
sid, or uiixture of glucosids. olitaincd from stro- 
pbantbus. 

.\vcragc dose: (i.nii;; -ni. ((>.;; mg. or 1/200 
grain). 

STitoi'iiANTiirs. — r. S. I*. This consists oi' 
the ripe .seeds of Slrophujilli ti.s Kunibv. 11 is pret- 



342 PHARMACOPEIA AND PHYSICIAN. 

erably administered in the form of the official 
tincture. 

TiNCTURA Strophanthi. — U. S. P. — This 
preparation now represents 10 per cent, of the 
drug in 65 per cent, alcohol, and is double the 
strength of the tincture official in the U. S. Phar- 
macopeia, 1890. 

Average dose: 0.5 c.c. (8 minims). 

Apocynum. — U. S. P. — This is the dried rhi- 
zome of Apocynum cannahinum, or of other close- 
ly allied species of Apocynum. This drug is said 
to have been used by the American Indians in 
various ailments, and has long been in use as a 
household remedy. More recently it has again 
attracted attention by its possible uses as a circu- 
latory stimulant, though the practical results that 
have been attained so far do not appear to warrant 
its use in all cases. The only official preparation is: 

Fluidextractum Apocyni. — U. S. P. — The 
Fluidextract of Apocynum is directed to be made 
with a mixture of 10 per cent, of glycerin, 60 per 
cent, of alcohol and 30 per cent, of water. 

Average dose: 1 c.c. (15 minims). 

Convallaria. — U. S. P. — This consists of the 
dried rhizome and roots of Convallaria majnlis. 

Average dose: 0.5 gm. (71/2 grains). 

Fluidextractum CoxvALLARiiE. — U. S. P. — 
This is made with a mixture of 65 parts of alcohol 
and 35 parts of water. 

Average dose: 0.5 c.c. (8 minims). 

THERAPEUTIC ACTIONS OF THE DIGITALIS GROUP. 

Digitalis will be referred to again under the 
heading of diuretics (Chapter XVI). 



CIRCULATORY STIMULANTS. 343 

As a circulatory stimulant one of the drugs of 
the digitalis group is indicated when the heart is 
M-eak and rapid and the blood pressure low, con- 
ditions which arise under a variety of circum- 
stances. 

In cardiac dilatation with wea^v systole digitalis 
affords our best remed}', as may be readily under- 
stood from the pharmacologic action. In pneu- 
monia the right ventricle suffers primarily and 
digitalis is indicated, for, while it affects the right 
ventricle less than the left, and the auricle least, 
tliis does not affect its usefulness in this condition, 
liecaiise the nutrition of the heart — both left and 
right — is supported by the improved coronary cir- 
culation, a most important factor, as we have seen, 
when extra work is thrown on the heart, and the 
pulmonary circulation is not affected directly by 
the general vasoconstrictor action of the digitalis. 
In this connection, the lengthened diastole, while it 
undoubtedly affords a better chance for the empty- 
ing of the pulmonary veins, is a factor of but 
minor importance. The use of digitalis in mitral 
insufficiency is familiar to all and the pharmaco- 
logic action readily explains its usefulness in this 
connection. 

Digitalis and its congeners arc said to be harm- 
I'ul in some cases of mitral stenosis, and they may 
fail to prove beneficial in insufficiency of the aortic 
valves. U is suggested ili;i( in (bis condition the 
Ijlood may gravitate from the brain through the 
aortic valve during the lengthened diastole. This 
action of the drugs also must be observed care- 
fully in these conditions and they must be with- 
drawn if they appear to be doing harm. 



344 PHARMACOPEIA AND PHYSICIAN. 

Drugs of the digitalis series are contraindicated 
in cases of fatty degeneration of the heart, since a 
lieart so weakened could scarcely support the addi- 
tional burden imposed by the increased arterial 
tension, and hypertrophy can not be expected to 
occur in such a heart. They are also contraindi- 
cated in all conditions in which an increasing 
l)lood pressure would be dangerous, for instance, 
in aneurism. 

AYith digito-xin particularly, one must constantly 
watch for the first symptoms of cumulative action, 
usually gastric disturbance, and it, or other mem- 
bers of the same group, should be temporarily 
withdra\\Ti when suggestive s}Tnptoms occur. 

The tincture of digitalis contains a larger pro- 
portion of the alcohol-soluble digitoxin than does 
the infusion, in which the digitoxin present is held 
in solution by means of digitonin. Digitoxin be- 
ing the most irritant of the known principles of 
digitalis, the infusion, containing digitalin prin- 
cipally, will often be preferred. 

AMien the heart is weak and irregular, digitoxin 
is proliably the most efficient remedy we possess for 
restoring it to normal contraction. An alcoholic 
solution of digitoxin may be used to advantage, 
provided it be well diluted with water when ad- 
ministered. 

The dose of digitoxin as given by the different 
authors is somewhat variable. Cushny states that 
1/12 mg. (1/750 grain) of crystalline digitoxin 
may be given three times daily. Schmiedeberg 
recommends 1/5 mg. (1/330 grain) of the crys- 
talline digitoxin three times dailv, and this has 



CIRCULATORY STIMULAXTS. 34.3 

been supjDorted b}- clinical experience. The physi- 
cian will do well not to exceed this latter dose too 
greath^, bearing in mind that cumulative effects 
sometimes develop quite suddenl}-, even with a 
dose which has been apparently harmless. 

Digitoxin and digitalin, pure or in the leaf, are 
changed into substances with a convulsive action 
in the presence of moisture, by bacteriologic ac- 
tion, hence old infusions should not be used nor 
should those leaves be employed which bear evi- 
dences of not having been properly dried and care- 
fully preserved. 

Wlien Oloetta announced the discovery of a sol- 
uljle amorphous form of digitoxin, which he 
named Digalen, it was generally accepted because 
of Cloetta's standing in the scientific world, but it 
appears that this preparation has no advantages 
over other prc'i^arations of digitalis, that it is not 
an aqueous preparation, that its subcutaneous use 
is painful and finally that it difi'ers but little from 
a hydroalcoholic solution of ordinary digitoxin. 

It is to be hopetl lb at in the next revision of the 
I'harmacopeia digitalis leaves will be directed to 
be piiysiologically assayed, dried with proper care 
and sealed with the date of assay, for the leaf so 
j)repared has proved more satisfactory in the hands 
of many clinicians than any of the isolated priu- 
ciplcs or llic (ialenical preparations of the dni^-. 

Digitoxin and digilaliii iii;iy be l;c|)( dissoUcd 
in alcohol and diluted as i-ci|iiinMl. Tlio dose oL' 
digitalin, or digitaliiiiiiii \cniiii, is Cioin 2 tod iiig. 
(l/;}() to J/10 grain) tlirce tijnes daily. 



340 PHARMACOPEIA AND PHYSICIAN. 

Digitoxin ma}^ be i^rcscribed as follows : 

R. Digitoxini (cryst.) gr. 1/12 |005 

Alcohol, q. s. "ad fgiii 100| 

M. Ft. solutio. 

Sig. : One teaspoonful in a little water three times a 
day. 

Digitalin can be prescribed in tbe same way, but 
0.05 is nsed in place of 0.005 gm. thus : 

I^. Digitalini veri gr. i [05 

Alcohol, q. s. ad f giii 100| 

M. Ft. solutio. 

Sig.: One teaspoonful in water three times daily. 

The tincture of digitalis, diluted with' water, 
is given alone three times a day. Owing to the 
slow excretion it is not necessary to repeat the dose 
more frequently, and the drug should be stopped 
for two days about once a week to avoid cumu- 
lative effects, whether one of the active principles 
or a Galenic preparation of digitalis is being used. 

Sollmann has suggested that strophanthin may 
deserve an even greater popularity than digitalis, 
and this suggestion has found support in more re- 
cent investigations. Strophanthin is now official 
whereas the active principles of digitalis have not 
as yet been included in our Pharmacopeia. 

Strophanthin causes but little vasoconstriction 
and itj therefore, deserves the preference over digi- 
talis and its principles when increased blood pres- 
sure is to be avoided. Thus, when dilatation of 
the heart is due to high blood pressure from in- 
creased arterial tension, strophanthin may be 
used, or, if digitalis is employed, a vasodilator such 
as nitroglycerin or one of the nitrites should l)e 
given at the same time. 

Because of its more prompt effect on the heart, 



CIRCULATORY 8TIMULAXTS. 347 

strophanthin may be employed to usher in the 
action when digitalis is to be employed. This 
promptness of action would also render it prefer- 
able to digitalis in shock or collapse were it not 
that the vasoconsti'ietor action is wanting. 

Digitalis, or one of its principles, may be given 
several hours before an operation when there is 
reason to apprehend shock, so that its action may 
coincide with the time that shock occurs instead of 
waiting till that condition has actually developed 
before giving the slowly acting remedy. 

Strophanthus seed and the tincture were for- 
merly of very variable quality, Init at the present 
time they are fairly uniform. 

Strophanthin, the active principle of strophan- 
thus seed, is of constant composition, is very solu- 
l)le in water and may, therefore, be dispensed in 
simple solution. However, it undergoes decompo- 
sition, in aqueous solutions, and it is, therefore, 
better to prescriljc it in diluted alcohol: 0.01 gm. 
(1/5 grain) may be directed to be dissolved in 
100 c.c. (3 fluidounces) of diluted alcohol and one 
teaspoonful of this solution, diluted with water, 
may be given three times a day. 

The official strophantliin must not be confused 
with crystallized strophanthin, g-strophanthin, 
gratus strophanthin or strophanthin Thorns, as it 
is variously termed, which is obtained from the 
seeds of strophanthus gratus, and which is rec- 
ommended in doses of 5 milligrams (1/13 grain) 
or .30 milligrams (i/. grain) per day, while as 
much as 0.075 gm. (1^4 grains) per day have 
Ix-cn given to an adult. Gratus strophanthin is 
said to be identical with oualjain, l)iit lliat, on tbe 



348 PHARMACOPEIA AM) PHYSICIAN. 

other liand. has been said to be much more toxic, 
to the frog's lieart at least, than ordinary stro- 
phantliin. Tbe dose of stroplianthip gratus men- 
tioned above is only for internal use, as the gluco- 
sid is much more toxic when used subcutaneously. 

We may call attention to the fact that the dose 
of strophanthin given in the Pharmacopeia — 1/3 
mg. (1/200 grain) — is smaller than that contained 
in the ordinary dose of the tincture, 0.5 c.c. (8 
minims), of which certainly represents more than 
lialf a milligram (1/135 grain) of strophanthin, 
and it has been suggested that the latter has been 
advised in wholly inadequate doses. It is extreme- 
ly toxic, however, and the dose must be increased 
only witli great caution. 

Dr. H. C. Wood, Jr., recommends Canadian 
hemp as a satisfactory and reliable circulatory 
stimulant, but as his published work appears to 
have been done with a fluidextract of Apocynum 
cannahinum and as the Pharmacopeia itself recog- 
nizes closely allied species of apocynum, that may 
or may not have similar physiologic properties and 
therapeutic uses, it may be well to await the re- 
sults of further investigations before trusting too 
implicitly in the possible results to be obtained 
from this drug. 

Other official memljers of this group have little 
to recommend them in preference to the more 
prominent ones just described. 

It might be added that the alkaloid of tlie supra- 
renal gland is not suited for long continued admin- 
istration. It does not influence blood pressure 
when given by the stomach, and l)ut slightly or 
not at all when injected just l^eneath tlie skin. 



CIRCULATORY STIMVLAyTS. :34!) 

When injected into the muscle there is a transient 
rise of blood pressure. Its local use has been dis- 
cussed at greater length in connection with as- 
tringents (Chapter VIII). 

STRYCHXIX. 

Strychnin, unlike digitalis, has no perceptible 
direct action on the lieart when therapeutic doses 
are used, but it produces its circulatory effects 
wholly by its influence on the centers, except in 
so far as the local action on the alimentary canal 
is concerned; this may be disregarded in the pres- 
ent consideration of strychnin, which is commonly 
injected hypodermically when its circulatory ef- 
fects are desired. 

Therapeutic doses of strychnin cause a rise of 
blood pressure by stimulation of the vasomotor 
center; the reflexes are increased, leading to im- 
proved tone of the voluntary muscles, and in- 
creased muscular activity always tends to increase 
the heart rate; this tendency, however, is counter- 
acted by the stimulation of the vagus center by 
strychnin, tlie heart being slowed or showing littlo 
(•bange in frequency. When the slowing is exces- 
sive there is a fall of blood pressure despite the 
vasoconstriction, but this does not usually occur. 
If the tendency to increased frequency predomin- 
ates over tbe vagus stimulation the rise of blood 
pressure is further augmented. 

As strychnin operates readily to produce its ef- 
fects it is a most valuable remedy when a quick 
rise of blood pressure is required. So rapidly are 
its effects elicited that convulsions may occur in a 
frog within two minutes of Die injection of a toxic 



350 PHARMACOPEIA AND PHYSICIAN. 

dose, and after a massive dose a rabbit may give a 
single convulsive leap into the air and be appar- 
ently lifeless from paralysis of the respiratory and 
other centers when it strikes the operating table. 

Biberfeld has investigated its mode of action 
on the respiratory center. He depressed the res- 
piration by morphin, after Mdiich str3^chnin was 
injected; this usnally resulted in a greater in- 
crease in the volume (sometimes even exceeding 
that before the administration of morphin) than 
in the frequency. 

The following preparations are official : 

Strychnina.^ — U. S. P. — This is an alkaloid 
obtained from nux vomica; it is also obtainable 
from other plants of the Loganiacew. 

Strychnin is only slightly soluble in water, 1 to 
6400, but it is soluble in 110 parts of alcohol. 

2. Owing to the frequency with whi'ch poisoning by strych- 
nin occurs, its toxicology deserves brief mention here. 

As is well known, strychnin causes a characteristic type 
of convulsion rather closely resembling tetanus. The amount 
of the alkaloid that is necessary to produce this toxic effect 
Is much greater, however, than is usually supposed ; but, ou 
the other hand, when once a large amount has actually en- 
tered the circulation, there is little hope of ultimate recovery. 
As death is due to paralysis of the respiratory center life 
may be prolonged, and a possible recovery brought about, by 
carrying on artificial respiration. This, however, should be 
begun before natural respiration ceases or even before It be- 
comes very greatly depressed. 

Strychnin requires several days (3 to 8) for its total elimi- 
nation. Diuretics hasten elimination and may be of benefit 
when the amount of the poison that has been taken does not 
greatly exceed the minimum fatal dose. 

Cushny advises strong tea (infusion) when the patient is 
seen with the strychnin in the stomach. This advice seems 
to be based on a misconception of the capacity of tea tannin 
for forming the insoluble tanuate. 

The fact that strychnin acts directly by paralyzing the re- 
spiratory center fully explains the possible danger that may 
result from the use of a stomach tube, and it will not be nec- 
essary to repeat this frequent caution. 



CIRCULATORY STIMULANTS. 351 

STRTCHNlN-iE SULPHAS. — U. S. P. — This is the 
salt of str3X-hnin that is most extensively used in 
this country; it contains five molecules of water 
and approximately 78 per cent, of strychnin alka- 
loid. Strychnin sulphate is soluble in 31 parts 
of water and in 65 parts of alcohol. 

On the continent of Europe the preference is 
usually accorded to the nitrate. This is official in 
our Pharmacopeia as : 

Strychnin"^ ISTitras. — U. S. P. — This repre- 
sents 84 per cent, of strychnin alkaloid and is solu- 
ble in 42 parts of water or in 120 parts of alcohol. 

The average dose of either of the official prep- 
arations is given as 0.001 gm. (1 mg. or 1/64 gr.). 

Strychnin is useful in all forms of low blood 
pressure because of its action on the vasomotor 
center. 

There can be little doubt of the beneficial ef- 
fects of strychnin in many cases of shock or col- 
lapse, but when irrecoverable shock exists it ap- 
pears to depress further the centers after an ex- 
tremely brief stimulation.^ 

To secure its greatest usefulness in conditions of 
this kind strychnin should be given hypodermic- 
ally, or to secure an even quicker action it should 
be injected deeply into the muscle of the arm or 
tliigh. This method of hypodermic injection is 

3. Crilo deflnos surgical shock as an exhaustion of the 
vasomotor centers, the cardiac and respiratory centers being 
only secondarily Involved, and collapse as due to a suspen- 
sion of the functions of the cardiac or vasomotor centers or 
to hemorrhage. Of course, an exhausted or paralyzed 
structure can not be stimulated. Sollraann defines both shock 
and collapse as a sudden depression of the activity of the 
medullary center; If of reflex origin, shock; if direct, col- 
lapse. We employ the terms in the latter sense. A depressed 
renter may be stimulated. 



352 PHARMACOPEIA AND PHYSICIAN. 

usually to be preferred, as it is less painful than 
injections just beneath the skin. 

Str3^chnin is one of the best respiratory stimu- 
lants and in an emergency large doses may be 
given. It is always to be remembered that strych- 
nin is a remedy for the crisis and is not to be 
used as digitalis is, to maintain blood pressure for 
a considerable length of time. 

AVhen paralysis of the limbs is due to a lesion 
in the cord which completely blocks the transmis- 
sion of nerve impulses strychnin can do no good, 
since it has no peripheral action, but if the paraly- 
sis results. from a lesion in the brain the increased 
reflexes which strychnin causes will serve to delay 
muscular atrophy. It may also serve to restore the 
tone of the reflexes when these are lowered by 
functional disturbances of the cord. Thus incon- 
tinence of feces and urine may be relieved when 
these are due to the lowered reflex centers for the 
sphincters of the bladder and anus. 

Caffein is closely related to strychnin, to which, 
however, it is greatly inferior, so far as any in- 
fluence on the circulation is concerned. It stimu- 
lates the vasomotor and respiratory centers and is 
useful, therefore, in the treatment of poisoning by 
morphin and other narcotics, in the form of strong 
tea, but strychnin serves the same purpose and 
perhaps more efficiently. 

Hoffmann noticed that theobromin possessed a 
stimulant action on the myocardium, similar to 
that sho-wTi by caffein, but no vasoconstrictor effect. 
In therapeutic doses of either agent, however, this 
cardiac effect is of little importance. 



CIRCULATORY STIMULANTS. 353 



Atropin causes acceleration of the heart b}^ par- 
alyzing the vagus endings, and this also causes an 
increased systole and a lessened diastole. The 
rate of the heart may be twice as great as under 
normal conditions, the result being a considerable 
increase in the output of the heart in a unit of 
time. 

The effect on the circulation of the increased 
heart action is supplemented by the constriction 
of the arterioles of the splanchnic area, due to 
stimulation of the vasoconstrictor area, due to 
stimulation of the vasoconstrictor center by atro- 
pin, which also stimulates the vasodilator center 
for the vessels of the skin, particularly those of the 
face and neck, but this is of comparatively little 
influence on the general blood pressure which rises 
in response to the two actions just mentioned. 

The influence of atropin on the heart rate is 
much less in children and in old age than it is be- 
tween the ages of 20 and 60 years, because the 
vagus inhibition is slight at the extremes of life 
in man. The vagus is much more active in some 
animals than in others. In this respect the dog 
resembles man. 

Atropin may cause a brief but unimportant 
slowing of the heart, due to stimulation of the cen- 
ter, preceding the acceleration which depends on 
the paralysis of the vagus endings. A^Hiilc it has 
been undeniably shown that atropin may power- 
fully stimulate the myocardium, this efTect with 
therapeutic doses is so slight that it may be en- 
tirely disregarded. Atropin acts as a stimulant to 
the respiratory center, but it is inferior in this re- 



354 PHARMACOPEIA AND PHYSICIAN. 

spect to stiychnin; it increases the rate, and prob- 
ably the depth, of the respiration. 

The central action of atropin is exerted mainly 
on the motor area, but it has been suggested that 
the differences between the action of atropin, 
caffein and strychnin on the various parts of the 
central nervous system are in degree rather than in 
kind. Thus, while caffein acts mainly on the 
higher centers in man, stimulating the psychic 
functions, it is capable of causing strychnin-like 
convulsions in the frog. All three act as powerful 
respiratory stimulants in mammals. 

Atropin is official as : 

Atropina. — U. S. P. — Atropin is an alkaloid 
prepared from Atropa Belladonna, or from other 
plants of the same family. It is soluble in 450 
parts of water and in less than 2 parts of alcohol. 

Atropine Sulphas. — U. S. P. — This salt of 
atropin is official in many, if not all, pharmaco- 
peias and is the best known and most widely used 
preparation of the atropin group. It is soluble in 
less than 1 part of water and in 4 parts of alcohol : 

Average dose (alkaloid or salt) : 0.0004 gm. 
(0.4 mg. or 1/160 gr.). 

Atropin is indicated when the lieart is consider- 
ably slowed. For this purpose the average dose 
given above is not usually sufficient, about 1 mg. 
(1/65 grain) being necessary to increase the rate; 
so large a dose being necessary to produce paral}'- 
sis of the vagus endings in the heart. It must be 
remembered, however, that in children and in the 
very old (after 70) the effect to be expected is 
much less than that seen between the ages of 20 
and 60. This larger dose causes stoppage, or, at 



CIRCULATORY STIilULAMS. 355 

least, a marked diminution of salivary secretion 
with consequent dryness of the mouth and throat. 

Wliile atropin has been used in shock and col- 
lapse, it can have but little influence on blood pres- 
sure or respiration in such cases. Atropin may be 
used to determine whether an abnormally slowed oi' 
intermittent heart results from central influences 
or from causes within the heart itself, since it cuts 
off all impulses from the center arriving through 
the vagus, but produces no appreciable effect if the 
cause lies within the heart. 

Atropin has been used to prevent the reflex stop- 
page of the heart occurring at the commencement 
of anesthesia, but it has been shown that there is 
no danger of such a catastrophe if the anesthetic 
is not used in too great concentration. 

Poisoning by certain fungi which contain mus- 
carin, while rare, may best be treated with moder- 
ate doses of atropin. Pilocarpin is also antag- 
onized in nearly all of its actions by atropin, but 
tlie latter does not counteract the cardiac effects 
of physostigmin, which acts on the myocardium. 

The value of atropin in opium poisoning has 
been much disputed. It seems to possess no ad- 
vantage over caffein and strychnin in such cases 
and it has the disadvantage of adding to the de- 
pression of the respiratory center if more than a 
therapeutic dose is given. Clinical experience seems 
to have abundantly proved that small doses of atro- 
pin are corrective for ordinary doses of morphin, 
and it is almost universally so used.* 

4. A widely used combination consists of morpbin sul- 
phate O.Ol.'j gm. C/i grain) and atiopln sulphate 0.0004 gm. 
d/l.')© grain) prepared In the form of the now popular hy- 
podermic tablets or dissolved in distilled water sullicient for 
one dose. 



356 PHARMACOPEIA AND PHYSICIAN. 

Atropin is usually given hypodermically when 
the central effects are desired. 

CAMPHOR. 

In shock or collapse camphor given by the stom- 
ach produces a feeling of warmth and probably 
acts reflexly for the most part. The respiratory 
and vasomotor centers, as well as the heart muscle, 
are stimulated, thus causing a rise of blood pres- 
sure. The heart is usually slowed and the con- 
traction strengthened. Camphor is almost insolu- 
ble in water and only slightly volatile at the body 
temperature, and its action, therefore, is very un- 
certain; 0.03 gm. (1/4 grain) may improve the 
]iu]se in some cases, while twenty times as much 
may be required in others ; hence but little reliance 
can be placed on it in crises, though it is very often 
effective. The spirit, diluted with water, is fre- 
quently used for internal administration. A num- 
Ijer of camphor derivatives have been employed 
from time to time, but they have not been shown 
to possess any advantages over camphor itself, or 
one of its more simple preparations. 

C AMPHORA. — U. S. P. — Camphor is a white, 
volatile, solid substance having a crystalline struc- 
ture and a characteristic aromatic odor and taste. 
Cam|)hor has been used in the Far East for many 
centuries, but was not known in Europe until in- 
troduced by the Arabians. It is now official in all 
pharmacopeias. 

Average dose: 0.12 gm. (2 grains). 

Aqua Camphor.^;. — IT. S. P. — This is a satur- 
ated solution of camphor in distilled water. It is 



CIRCULATORY STIMULANTS. 357 

frequently used as a vehicle for other medical sub- 
stances. 

Average dose: 4 e.c. (3 fluidrams). 

Spiritus Camphor.^-:. — U. S. P. — This is a 10 
per cent, solution of camphor in alcohol. 

Average dose: 1 c.c. (15 minims). 

LiNiMEXTUM Camphors. — U. S. P. — This 
jjreparation, variously known as camphor liniment 
and camphorated oil, contains 20 per cent, of 
camphor dissolved in cottonseed oil. While large- 
ly used as a mildly rubefacient local application it 
is not infrequently used for hypodermic injections 
or for the internal administration of camphor in 
the form of an emulsion. The average dose would 
be al)out half of that given under spirit of cam- 
phor. 

Camphor is frequently employed as a diapho- 
retic, particularly in combination with other 
agents, because of its stimulation of the vasodila- 
tor centers for the cutaneous vessels. 

As noted above, camphor water alone has little* 
therapeutic value and is useful mainly as a vehicle 
for other substances. Camphor may be given in 
pill form, in capsules or in the form of an emul- 
sion. Probably the best method of administering 
camphor consists in suspending the finely pow- 
dered substance in twenty parts or more of milk. 
For this purpose from twenty drops to one tea- 
spoonful of the spirit of camphor may be directed 
to be given in one or two tablespoonfuls of milk. 

The several preparations of camphor are com- 
monly employed externally as a mild rubefacient, 
l»nt tlie action of camphor when applied in this 
way is largely, if not entirely, a local one. 



PHARMACOPEIA AND PHYSICIAN. 



MoscHus. — U. S. p.— This substance has been 
used in Europe for several centuries, and in China 
and other far Eastern countries from time im- 
raemoriaL The portion that is now official is de- 
scribed as "The secretion from the preputial fol- 
licles of AloscJius moschiferus" (musk deer), an 
animal which inhabits Thibet and other parts of 
Central Asia. 

Average dose: 0.25 gm. (4 grains). 

TiNCTUEA MoscHi. — U. S. P. — This represents 
5 per cent, of musk in diluted alcohol. 

Average dose: 1 c.c. (15 minims). 

Musk was brought forward nearly a century ago 
as a powerful circulatory stimulant, and S. Solis- 
Cohen recently recommended it as an efficient and 
dependable remedy when it can be obtained of 
good quality, but it is extremely expensive and 
subject to gross adulteration. 

Musk probably resembles camphor in its action 
' on the centers and has the advantage of greater 
solubility in proportion to the amount required. 

Castor fiber and sumbul root, which have been 
recommended as substitutes for musk, are entirely 
devoid of any such central action as that claimed 
for the latter. 

Musk may be given in capsules, or in some cases 
the tincture may be preferred. 

AMMONIUM PREPARATIONS. 

Miile ammonia, as one of the products of the 
decomposition of nitrogenous materials, was 
known from a very early period, the volatile salts 
of this substance were not available in Europe as 



CIRCILATORY ,ST1MVLANTS. 359 

medicines until after the thirteenth century, when 
Ea^Tiiundus Lullus first produced ammonium car- 
bonate from urine. The stimulating action of tliis 
salt, it is said, was kno-«Ti for man}^ centuries to 
the Hindoos, and was probably Imown to the 
Arabians. It is now official as : 

Ammoxii Carboxas. — ^U. S. P. — This is a 
white, hard, translucent solid having the charac- 
teristic odor of ammonia and a sharp saline taste. 
The official salt is described as being "a mixture of 
acid ammonium carbonate and ammonium car- 
bamate.'^ 

Average dose: 0.25 gm. (4 grains). 

Aqua Ammonia. — JJ. S. P. — This is an 
aqueous solution of ammonia containing 10 per 
cent., by weight, of gaseous ammonia. 

Average dose: 1 c.c. (15 minims). 

Spiritus Ammoni.!!: Aromaticus. — U. S. P. — 
This is a hydroalcoholic solution containing 3.4 
per cent, of ammonium carbonate, 9 per cent, of 
ammonia water and 70 per cent, of alcohol aroma- 
tized with oil of lemon, oil of lavender flowers, 
and oil of nutmeg. 

Average dose: 2 c.c. (30 minims). 

The volatile salts of ammonium, in the form 
of the well-known "smelling salts," are very com- 
monly employed by inhalation for their reflex ef- 
fects on the respiratory and cardiac centers. The 
aromatic spirit of ammonia when taken by llic 
stomach has a similar action. Other actions of 
ammonium salts have been enumerated in previous 
chapters. 

The water of ammonia, wlien taken internally, 
merely acts as a caustic alkali. It is seldom so 



3(i0 PHARMACOPEIA AND PHYSICIAN. 

used. The aromatic spirit is usually added to 
water at the moment of taking. 

Smelling salts consist of varying mixtures of 
anmionium carbonate, or of ammonium chlorid 
with potassium carbonate, and spirit of ammonia, 
to which oil of lavender flowers is usually added 
as an aromatic. 

ALCOHOL AND DERIVATIVES. 

Alcohol has been considered under dietetics. 
Chapter VII, and it will be mentioned here only 
so far as it affects the circulation. 

Small doses increase the pulse rate slightly by 
direct action on the cardiac muscle, and reflexly 
also, from the stomach if the alcohol has been 
taken in a concentrated form. Large doses de- 
crease the rate by a stimulation of the vagus. 

The dilation of the vessels of the skin is a mat- 
ter of very common observation. This leads to a 
fall of temperature, even though it gives rise to a 
feeling of warmth in the skin. The general blood 
pressure rises somewhat after small doses, but 
falls after large amounts. 

Alcohol, or distilled spirit, was probably intro- 
duced into Europe by the Arabians in the tenth 
or eleventh century.^ Apart from the several 
forms of alcohol that are official we have : 

Spiritus Frumenti. — U. S. P. — An alcoholic 
liquid obtained by the distillation of the mash of 
fermented grain, such as Indian corn, rye, wheat 
and barley, or their mixtures. To conform with 
the official requirements, whisky should be at least 

5. According to Pereira the Arabians obtained their 
knowledge of distilled spirit from the Chinese, who knew 
and used it at a much earlier period. 



CIRCVLATORY STIMULA^'TS. 301 

four years old and comply with a number of physi- 
cal requirements and chemical tests that are now 
provided. 

Spiritus Yixi Gallici. — U. S. P. — Brandy. 
This is an alcoholic liquid obtained by the distilla- 
tion of the fermented unmodified juice of fresh 
grapes. Like whisky, it should be at least four 
years old and should conform to the tests for iden- 
tity and purity that are described in the Pharma- 
copeia. 

^THER. — U. S. P. — Ether or ethyl oxid was 
discovered by Valerius Cordus, about 1540, and 
described as "Oleum vitrioli dulce." The prepara- 
tion appears to have been entirely forgotten and 
was rediscovered by Frobenius, a London apoth- 
ecary, about 1730. 

Sulphuric ether, the name given it at the time, 
although long known to l)e a misnomer, is still re- 
tained in connection with commercial varieties of 
the substance. 

Average dose: 1 c.c. (15 minims). 

Spiritus ^Etheris. — U. S. P. — This contains 
.32.5 parts of ether and 67.5 parts of alcohol. 

Average dose: 4 c.c. (1 fluidrara). 

Spiritus .^Etheris Compositus. — U. S. P. — 
This preparation, more popularly known as Ilof]'- 
mann's anodyne, contains 2.5 per cent, of ethereal 
oil, in addition to the ether. It has no evident 
advantages over the simple spirit of ether and may 
be given in the same dose. 

Alcohol in the fomi of whisky or brandy is 
inucli used in shock or collapse in connection with 
other agents, such as strychnin and digitalis. Its 



362 PHARMACOPEIA AND PHYSICIAN. 

value is strongly asserted by some authorities and 
disputed by others. Ordinary doses of alcohol 
liave little effect on the circulation in animals, but 
clinical evidence seems to prove that alcohol does 
possess some value in the conditions mentioned, 
particularly when a very brief respite for the heart 
tides over a crisis. Spirit of ether may be given 
by the stomach, or used by hypodermic injection, 
and probably acts reflexly on the centers in such 
cases. 

ERGOT. 

Ergot has been recommended in shock and in 
hemorrhage in inaccessible locations. The use in 
the latter condition is based on its undoubted 
power of causing vasoconstriction in certain areas. 
It is much less useful than strychnin in shock be- 
cause of its slow action, and in hemorrhage there 
is no reason to expect a greater vasoconstriction at 
the bleeding point than elsewhere and a rise in the 
general blood pressure beyond that necessary to 
sustain the circulation in the medulla, is contra- 
indicated in hemorrhage. This, of course, does 
not apply to postpartum hemorrhage, because er- 
got has a specific action on the uterus, causing a 
firm contraction and thereby closing the bleeding 
vessels by compression. 

Sollniann and Brown have recently studied the 
action of ergot when injected intravenously into 
dogs.^ They found that it influenced the general 
circulation but little, particularly when the blood 
pressure was much lowered, and that it caused a 
temporary fall in the blood pressure Avith speedy 

6. The Joukxal A. M. A., July 22, 1905, p. 229. 



CIRCULATORY STIMULANTS. 363 

recovery, generally followed by an unimportant 
rise. The effects were mainly due to the action 
on the heart; as the vasomotor action was very 
slight. 

The further discussion of its obstetrical use does 
not belong here. 

Ergota. — U. S. P. — The sclerotium of Claviceps 
purpurea, gathered from rye, and not more than 
one year old. 

While ergot has been used in Germany for cen- 
turies as a household remedy, it was not generally 
recognized as an efficient drug until some time 
after 1777, when Desgranges j^nblished several es- 
says on the use of ergot. 

The vasoconstrictor properties of this drug ap- 
pear to be due to the alkaloid cornutin, discovered 
by Kobert in 1884, and more fully descri1)ed by 
Keller in 1894. 

ExTRACTUM ERGOTiE. — U. S. P. — This is a 
hydroalcoholic extract of ergot partially purified 
l}y the addition of hydrochloric acid subsequently 
neutralized with sodium carbonate. It should rep- 
resent eight times its weight of ergot. 

Average dose : 0.25 gm. (4 grains) . 

Fluidextractum ERGOTiE. — U. S. P. — This is 
directed to be made with diluted alcohol that has 
l)ecn acidified by the addition of acetic acid. 

Average dose: 2 c.c. (30 minims). 

VixuM ErcotvE. — U. S. P. — This represents 20 
per cent, of the fluidextract of ergot in fortified 
white wine. 

Average dose: 8 c.c. (2 fluidrams). 



3()4 PHARMACOPEIA AND PHYSICIAN. 

Ergot is preferably given in the form of the 
fluidextract without other additions. There are 
a number of water-soluble preparations on the 
market at the present time that are intended for 
hypodermic use, which, it is claimed, possess all 
the active principles of ergot, without the odorous 
and nauseating constituents. 



CHAPTER XV. 

CJKCULA'J'ORY DEPKES8ANTS. 

'I'ho circulation may be depressed l)v acting on 
those structures the stimulation of which causes an 
increase in blood pressure. Hence we might divide 
these agents into two grou^js: 1. Those acting on 
the heart mainly, directly or through the centers. 
2. Those acting for tlie most part on the vessels, 
directly or indirectly. 

An agent which s1oa\-s the lieart without caus- 
ing a compensating increase in the strength or the 
amplitude of the contraction, or a constriction of 
the vessels, must cause a fall in the arterial pres- 
sure, as will be readily understood by reference to 
wliat has previously been said in regard to acceler- 
ation of the heart causing a rise in pressure. Plere, 
too, we have in every case a combination of effects, 
and the resulting change in tlie cii'cidation nuisl 
(|c])ciiil on the predominance of one or anotlici-. 
As a matter of fact, we have no circulatory depres- 
sant which is used thei-a])eutically to slow tlie 
licart by direct action (in tlic myocardiiiin, l)iil 
thi-rc arc a luinibcr wliicli iii(hicc slowing by in- 
direct acticm. 

ACOXITR. 

'I"h(!rapeutic doses of aconite cause slowing;- of 
tbe lieart by stimulating ibe vagus cenlei-. uith- 
onl iiialci-iiilly alVecling ll„. sircngtb of Ihc in- 
(li\iihial cunliaclions or Ibc condition of ibe vaso- 



;i(i(l I'HARMAVOI'EIA AND PHYSICIAN. 

motor center. The result, therefore, is a fall in 
arterial pressure. 

The lessened cardiac action is accompanied by a 
decline in the temperature, whether this was pre- 
viously normal or that of fever. The effect is 
commonly ascribed to the change in the- circula- 
tion, but it has not been proved that the heat 
regulating center is not involved in the action. 

It will be noticed that the effects of digitalis 
and aconite on the circulation are diametrically 
opposed, except for the slowing of the pulse rate, 
which both induce. 

Toxic doses of aconite act directly on the heart, 
causing acceleration with diminished force of con- 
traction. In mammals the acceleration is pre- 
vented for a time by the vagus stimulation, and 
the heart is actually slowed, but in reality only a 
therapeutic dose has been absorbed in the early 
stage of the action; this stimulation rapidly gives 
place to depression and then to paralysis of the 
center, the acceleration becoming marked and be- 
ing soon followed by great irregularity. Delirium 
cordis occurs before the heart stops in diastole. 

Paralysis of the respiratory center is usually the 
immediate cause of death ; hence atropin is capable 
of saving a certain percentage of animals experi- 
mentally poisoned with a barely fatal dose of acon- 
ite. If an excessive dose has been taken even ar- 
tificial respiration will prolong life only for a 
short time, as the heart soon becomes paralyzed 
after the phenomena enumerated above. 

AcoNiTUM. — U. S. P. — This is the dried tuber- 
ous root of Aconitum napcllus, collected in au- 
tumn. When assayed by the process given in the 



CIRCULATORY DEPRESSANTS. 307 

Plianiiacopeia it yields not less than 0.5 per cent, 
of acomtin. 

Despite the fact that it was well known and 
long in use as a poison, particularly for wild ani- 
mals, aconite is a comparatively recent addition 
to our materia medica, having been introduced by 
an Austrian physician, Storck, about 1762. 

Average dose: 0.05 gm. (1 grain). 

The official preparations of aconite are as fol- 
lows : 

Fluidextractum Aconiti. — U. S. P. — This is 
made with a mixture of 75 parts of alcohol and 25 
parts of water and should contain 0.4 per cent. 
of aconitin. 

Average dose: 0.05 c.c. (1 minim). 

TiNCTURA AcoxiTi.— U. S. P. — Tliis prepara- 
tion has been materially reduced in strength and 
now represents 10 per cent, of the crude drug, or 
approximately one-third of the strength of the 
tincture that was official in the Pharmacopeia for 
1890. 

It may be added that the change was made in 
conformity with the recommendations of the inter- 
national conference for the unification of formulas 
of potent medicaments and that, in addition to lac- 
ing in harmony with this international standard it 
will be found to be more uniformly active than the 
stronger but more varial)le tincture official in tlic 
cailier pharmacopeias. 

Average dose: O.G c.c. (ID iniiiims). 

AcoxiTiXA. — I). S. p. — This is an alkaloid ob- 
tained from aconite. It is the most active and 
most potent substance in the Phariuacopcia. The 
aconitin now official is the crystalline alkaloid aiul 



.308 PHARMACOI'JJIA AM) PHYSICIAN. 

hihould not be confoimded with tlie amorphous 
sul)stance formerly official or the comparatively 
weak eclectic prei^aratioii of aconite. 

Average dose: 0.00035 gm. (0.1,5 nig. or 1/400 
grain) . 

Aconite finds its greatest usefulness in cases of 
high blood pressure with a strong, rapid heart, 
particularly in fever in ro1:>ust persons. It then 
simply slows the heart, lessening its output and 
causing a fall in temperature and in arterial ten- 
sion. 

Fever alone is not an indication in every case 
for the use of aconite. In continued fevers and in 
any case in which the heart is feeble or the arterial 
tension low from any cause (even though the 
pulse may be rapid), aconite is contraindicated. 

Since the antipyretic benzene derivatives have 
come into general use the employment of aconite 
in fever has correspondingly declined, but we have 
seen that the s}Tithetic antipyretics are far from 
being the harmless substances that some of the 
manufacturers would have us believe, and aconite 
deserves to be used more frequently in suitable 
cases of fever. 

"Colds" are troublesome forms of congestion re- 
sulting from circulatory disturbances which are 
often relieved by repeated small doses of aconite. 
For this purpose 3 drops (about 1 minim) of the 
tincture of aconite of the present Pharmacopeia, 
which would be equivalent to about 1 drop (l/o 
minim) of the tincture official in the Pharma- 
copeia, 1890, well diluted with water, may be 
given every fifteen minutes for two hours, tlien 
hourly until relief is obtained. 



CIRCULATORY DEPRES>^A^'TS. 309 

Aconitin is so intensely irritant that it is not 
suitable for use without great dilution, and, as 
there is some chance of confusing the much more 
potent article now official with the eclectic or the 
amorphous preparations, it will be found prefer- 
able to use the tincture of aconite in nearly every 
case, more ])articularly, since this is now required 
to be of a definite aconitin strength. Because of 
its irritant action aconitin is not adapted for 
liypodermie use, but it may be given, largely 
diluted with water, as follows: 

Aquae, q. s. ad fgiv 120 

Alcohol fSiv 15 

Aqua% q. s. ad fgiv 120 

Sig. : A teaspoonful may be taken every three hours. 

The disadvantage, not to say danger, of trying 
to weigh such small amounts is apparent, and 
serves to further illustrate the advantage of using 
the tincture. 

The tincture is usually given alone, except for 
the water used in diluting it. 

vj:ratru:m. 
\'cratruiii i-alher closely resembles aconite in its 
tbciapcutic action, and it was widely used at one 
time for the reduction of fever. The extent of its 
use was largely due to its popularization in llie 
lonii of Norwood's Tincture of ^^eratrum, l)ut it 
seems to ])ossess no advantage over aconite, and ii 
is now but seldom used internally. 

VkKATKUM. — U. S. P. (VlClUTKUM VlUlUK.— 

IJ. S. P., 1890). — Under the single heading vera- 
trum, the Pharmacopeia now recognizes the dried 
rlii/.ome of Verutriiin viridc or of Vcralruin album. 
While it is tni<- tbiit tbere is no marked din'ei-ene(> 



370 PHARMACOPEIA AND PHYSICIAN. 

between the two drugs, some physicians prefer the 
American root and, therefore, should specify 
"Yeratrum viride, U. S. P., 1890." 

Average dose: 0.12 gm. (2 grains). 

The official preparations are: 

Fluidextractum Veratri. — U. S. P. — This is 
directed to he made with alcohol. 

Average dose: 0.1 c.c. (II/2 minims). 

TiNCTURA A-'eratri. — IT. S. P. — This prepara- 
tion represents 10 per cent, of the crude drug in 
alcohol and is practically one-fourth the strength 
of the corresponding preparation in the Pharma- 
copeia for 1890. 

Average dose: 1.0 c.c. (15 minims). 

Veratrina. — U. S. P. — This is a mixture of 
alkaloids obtained from the seeds of Asagrcea offi- 
cinalis. Veratrin should not be confounded with 
the eclectic preparation of the same name. 

Average dose: 0.002 gm. (2 mg. 1/30 grain). ' 

THE NITRITES. 

The nitrites, organic as well as inorganic, lower 
the blood pressure by causing vasodilation. Thera- 
peutic doses exert but little influence directly on 
the heart. It has been sho\\Ti that the nitrites act 
on the muscles and nerve endings of the arterioles, 
and that even the veins undergo dilatation. 

Any considerable dilatation of the arterioles 
and veins of the splanchnic area must inevitably 
lead to a decline in the general arterial pressure, 
regardless of the action on the heart. In man 
the heart actually does show acceleration in the 
first stage of the action with amyl nitrite because 
of tlie depression of the vagus center; the blood 



CIRCULATORY DEPRE.^i^AXTS. 371 

pressure remains high and the vasodilation affects 
the face and neck, because of depression of the 
vasoconstrictor centers for those areas; but, as the 
dilatation extends to the splanchnic and other 
areas, the general arterial pressure falls. 

There has been some diversity of opinion in re- 
gard to the effect of am^d nitrite on the cerebral 
circulation. Leonard Hill agrees with those who 
believe that there are no nerves controlling the di- 
ameter of the cerebral arteries, and he declares 
that the arterial pressure in the brain simply fol- 
lows that in tlie carotids. Wiggers has found that 
adrenalin constricts the cerebral vessels and we 
bave Elliott's dictum, based on his masterly re- 
search, that the constrictor effect of adrenalin on 
vessels is proof of sympathetic nervous control. 
Brodie and Dixon also found that the action of 
adrenalin is exerted on nervous elements. Should 
Wiggers' results be confirmed there would be little 
reason to doubt that tlie nitrites do affect the cali- 
ber of the cerebral vessels. 

The nitrites are capable of causing some dilata- 
tion of the vessels in excised muscles when the 
nerve endings are not concerned ; hence they must 
also act on the museiilai' elcniciils of the vessels to 
some extent. 

The nitrites produce methemoglobin in the 
!>lood, but do not cause the destruction of the cor- 
puscles, as other methemoglobin formers do, and 
in man this does not arrest oxidation completely, 
l)ecause-the tissues reduce methemoglobin slowly. 
'I'liis is not an important factor, however, with the 
llicrapeutic doses of the nitrites. 

0. Loeb suggested as a possible explanutiun of 



372 PHARMACOPEIA AND PHYSICIAN. 

tlie value of amyl nitrite in angina pectoris that 
the coronary vessels, like those of the face and 
brain, may be dilated at first, before the action on 
the general circulation begins. Filehne showed 
that the therapeutic dose of amyl nitrite caused 
vasodilatation by central action, and Loeb found 
it did not affect the vessel tonus independently ex- 
cept when in such concentration as to prove poison- 
ous. Small doses were found to have no constant 
effect on the vessels of the coronary circulation in 
the excised heart. Amyl nitrite acts very rapidly 
when inlialed, but the action is over in about 
twenty minutes. 

The effects of glyceryl trinitrate or nitrogly- 
cerin are much more slowly induced and they per- 
sist for some hours. Sodium nitrite is decomposed 
by the hydrochloric acid of the gastric juice, thus 
giving rise to irritation of the stomach. Gh'-ceryl 
trinitrate is not decomposed in the stomach, but it 
has the disadvantage of often causing headache. 
In some cases this action does not occur after the 
drug has been used for some time. Glyceryl trini- 
trate is decomposed in the blood, with the libera- 
tion of the nitrous acid radicle; hence it acts like 
the nitrites. 

Spiritus Glycerylis Kitratis. — IT. S. P. 
(Spiritds Gloxoini. — U. S. P., 1890) — Com- 
monly, though incorrectly, termed nitroglycerin, is 
an alcoholic solution containing 1 per cent, by 
weight of glyceryl trinitrate. 

iVverage dose: 0.05 c.c. (1 minim). 

Amylis IsTitris. — U. S. P. — This is a liquid 
containing about 80 per cent, of amyl nitrite. 

Average dose: 0.2 c.c. (3 minims). 



CIRCULATORY DEFRESt<AyT><. 373 

SoDii XiTKis. — U. S. P. — This usually occurs 
in white, or nearly white, fused masses, soluble in 
Il'SS tlian two parts of water. The salt deliquesces 
oil exposure to air and is also gradually oxidized 
to sodium nitrate and thus becouies unfit for use. 
Average dose: O.OG gm. (1 grain). 
The nitrites, and glyceryl trinitrate, arc oL' 
j)riine iuiportance in the dx;'pression of the circula- 
tion ami may 1)C used wlien it is deemed necessary 
to lower the blood pressure, for example, when a 
weakened heart is becoming exhausted by contract- 
ing against a great arterial resistance, and the con- 
tractions are incomplete, as in arteriosclerosis. A 
slight lowering of the aortic resistance often en- 
ables the heart to contract more perfectly while a 
coronary vasodilation secures a better nutrition of 
the heart. 

The group is contraiudicated, however, when 
the blood pressure is already low (however weak 
and rapid the heart may be), because a certain de- 
gree of arterial tension is al)s<ihilely essential for 
maintaining the coronary and meiluUary circula- 
tions. 

when a speedy 

iljncks n\' augiiia ])ee- 

.r tlie wssels is of 

usually gi\c reliel', 

lel-iosclei-osis. when 

has beeu re])laced by 

men of llic vessels, it 

an not he caused to 

Ihal. whil.' relief is 
allacks of the early 



Amyl ni 


trite is to 


be ])refe 


;i('l ioii 


is d. 


•sired, as in 


L acute 111 


lori<. 


Wli 


en the con 


striclion 


spasm 


.xlic 


origin the 


niti'iles 


l)Ut ii 


u lh( 


• later sta- 


res ol' a 


most 


of Ih 


r muscular 


lis>ue 1 


fibron 


s, Ihl 


IS nai'i'ouii 


Ig the lui 


is obvious 


tliat such 


vessels c 


dilate 


by any means. 




It 


must 


not be fo 


rp.llcu 


often 


obla 


ined in I In 


!■ acute 



374 PHARMACOPEIA AND PHYHWIAN. 

stages of angina pectoris, the nitrites are merely 
palliative and in no sense curative. The nitrites, 
and more particularly amyl nitrite, are indicated 
in vasomotor spasm occurring in any disease, un- 
less specifically contraindicated by other condi- 
tions. 

The action of arayl nitrite is very speedily eli- 
cited when it is inlialed, but when spasm of the 
respiratory muscles interferes with the inhalation 
it may be injected into the deep muscles of the 
thigh. 

Spirit of glyceryl trinitrate is to be preferred in 
chronic conditions of abnormally high blood pres- 
sure, because of its more protracted action. One 
minim is given three times a day, or the dose is 
increased till effective. It may be injected hypo- 
dermically or given by the stomach, as it passes 
through that organ unchanged, and, therefore, 
causes no such disturbances as are seen with so- 
dium nitrite. 

AVhile this substance is usually considered as be- 
ing extremely poisonous, it is said that large 
amounts have been given in the course of a day 
with no l^ad effects. Aqueous solutions of glyceryl 
trinitrate are unstable and are frequently quite 
worthless. The spirit sometimes gives almost im- 
mediate relief in headache, when this is attended 
with high blood pressure, but, on the other hand, 
it may increase the headache if the blood pressure 
is low. As is well knoA\Ti, the headache which 
glyceryl trinitrate commonly causes is one of the 
greatest objections to its use. 

The nitrites, and particularly the spirit of 
glyceryl trinitrate, may be used to counteract the 



CIRCULATORY DEPRESSAlsTS. 375 

vasocoustrictor effect of digitalis or stryclmin when 
that action is undesired. 

Spirit of nitrous ether does not yield enough of 
the nitrous acid radicle to exert any therapeutic 
action on the circulation. The action of the spirit 
is exerted reflexly as in the case of alcohol and 
ether. 

The spirit of nitroglycerin may be given in 
simple solution in order to avoid the measuring of 
such small does as one minim. It may be pre- 
scribed as follows : 

IJ. Spiritus iiitrogh'cerini ni. xv 1] 

Aquae ". fgii 6o| 

The dose of this solution is a teaspoonful. 
Large amounts should not be prescribed or dis- 
pensed. 

The following illustrates the method of pre- 
scribing sodium nitrite : 

IJ. Sodii nitritis gr. xv 11 

Aquae dest Sii 60| 

This solution should be kept well corked. The 
dose is one teaspoonful. 

The Avell-known "pearls*' of amyl nitrite afford 
the most convenient form for dispensing that sub- 
stance; they must be kept cool to avoid loss by 
breakage, and, when used, one is crushed in a 
handkerchief and the contents inhaled by the 
patient at once. 

Bloodletting was formerly in vogue as a routine 
jjrocedure wlien it was desired to reduce tlie blood 
pressure, but in healthy animals the vasomotor 
center exercises sucli perfect control over tlie blood 
pressure that tlie loss of blood produces very little 
lasting effect unless it is so great as to cause col- 



370 FHliniAVOl'ElA AXD I'HYHIGIAN. 

lapse symptoms. While the loss of a moderate 
amount of blood is Avell borne by robust patients, 
and ill some cases maj' even prove beneficial, acon- 
ite and the nitrites are nearl}- always to be pre- 
J'crred as temporary measures, while the control 
of the diet (including^ liquids) and the nse of 
saline purgatives will serve to diminisli the amount 
of blood for a longer time in suitable cases. 

Ilydrated chloral is one of the most effective 
agents in our possession for lowering the blood 
pressure by depressing the vasomotor centers, and, 
while this action is much employed in laboratory 
experiments, it is not elicited in man by perfectly 
^afe doses such as are used to induce sleep. 



CHAPTER XVI. 

DIUKETICS AXD DIAPHOEETICS. 

Diuretics and diaphoretics may Ije considered 
together, since they are often used for the same 
piu'iDose, the one being used to supplement the 
other, and because the same agent which produces 
diuresis nnder certain conditions may cause dia- 
phoresis when these conditions are sliglitly 
changed. 

Diuretics may be divided broadly into those 
which influence the circulation and those which 
act on the secretory cells of the kidney. Though 
the same agent may possess both actions to some 
extent, we shall consider these remedies with ref- 
erence to the principal effect according to this 
classification. 

While the exact mechanism of urinary secretion 
remains a problem, the indications for diuresis 
and the method of causing it are fairly clear. 
When the official remedies all fail to produce this 
effect we may usually attribute the failure to tlu' 
condition of the kidney, feeling sure that the secre- 
tory cells are incapable of performing their riiuc- 
tion and that nothing short of the creation of new- 
cells can be efl'ective. Even this task is not beyond 
the powers of some of the much-vaunt(>d mineral 
waters and nostrums if we are to believe llie state- 
menls made in the circulars and olliei' iidvei-l ise- 
menls of the proprietors. 

Diuretics are especially indicaled in (h()j)sv of 



378 PHARMACOPEIA AND PHYSICIAN. 

cardiac, or even of renal, origin, provided the cells 
are capable of free secretion. In renal dropsy 
agents of the first class (those which influence the 
circulation), or those which mildly stimulate the 
kidney cells without producing irritation, are to 
be preferred. If the renal cells are incapable of 
increased secretion, diaphoresis should be resorted 
to in order to give rest to the kidneys. 

Diuretics are also important in causing the re- 
moval of toxins and substances which form con- 
cretions (urates and phosphates). 

DIGITALIS. 

Nearly all authorities agree that digitalis is the 
most important of the official remedies in the 
treatment of dropsy of cardiac origin, its action 
being directed mainly toward the increase in the 
efficiency of the heart, with a consequently im- 
proved circulation in the kidney and increased 
diuresis. For this purpose the tincture is fre- 
quently employed, but, perhaps, the most efficient 
remedy is the combination of digitalis with squill 
and calomel, commonly called Niemeyer's pills.^ 

The official squill is too irritant to permit of its 
employment in nephritis. This is very important 
and should be borne in mind if one uses any of the 
much-heralded diuretic nostrums which contain 
squill or its active principles. 

1. The formula for this piU is as follows : 

Pulveris digitalis | 

Pulveris scillse, aa grs. x 160 

Hydrarg. chloridi mit grs. 1^4 108 

This amount is to be divided into ten pills, or preferably, 
capsules. One of these pills every three hours will be found 
effective. The calomel is often omitted, or it may be re- 
placed by 0.06 gm. (1 grain) of the blue mass (massa 
hydrargyri) in each dose, if it is to be made into pills, or 
gray powder (hydrargyrum cum creta), if into capsules. 



DIURETICS AXD DIAPHORETICS. 379 

That squill is extremely active in causing a 
watery diuresis is true, but in overdoses it is 
equally potent to lessen or even to suppress the 
flow by reason of its irritant action. This may 
result in bloody urine. 

The dose of squill, in powder, is 0.05 to 0.1 gm. 
(one or two grains) every three hours until some 
nausea occurs. 

Eather closely resembling digitalis in its action 
on the heart and as a diuretic, if, indeed, it may 
not surpass the older drug in the latter case, is 
strophanthus, which does not cause the same de- 
gree of vasoconstriction which sometimes inter- 
feres with or prevents the diuretic action of digi- 
talis. It is mostly used in the" form of the tinc- 
ture. 

While stroplianthus has some advantages, such 
as the more prompt action and a sligliter tendency 
to cause cumulative effects, clinicians have not 
found it so generally useful as digitalis. 

Apocynum has enjoyed a considerable reputa- 
tion in domestic practice as a remedy in dropsy, 
but appears to be inferior to digitalis in tlie same 
group with which it belongs. 

Digitalis, strophanthus, apocynum and other 
members of this group have been considered in 
( 'liapter XIV. 

CAFFEIN. 

AVhen cardiac stimulants or other agents cause 
such vasoconstriction as greatly to lessen the 
amount of blood wliicli passes tlirough the kidney, 
and consequently the diuresis, a vasodilator is 
Komotimes employed, but it is more rational to 
avoid tlie necessity for tliis when possible. 



380 J'JIAh'MACOPEIA AND I'HYSWIAN. 

Wlwn the ol)ject of diuresis is to get rid of fluid 
wliicli lias accumulated, it is, of course, better to 
avoid unnecessary amounts of Avater, and in such 
cases diuretics arc given in solid, or at least con- 
centrated, form. 

Calfein, theobromin, para-.xantliin and theocin 
are derived from xanthin by the introduction of 
methyl groups, caifein being trimethylxanthin, 
and theobromin, para-xanthin, and theocin being 
dimethylxanthins, the last three differing only in 
the arrangement of the methyl groups in the mole- 
cule. These dimethylxanthins act more strongly 
on the muscles of the vessels and cause a greater 
diuresis than does caffein, while the latter acts 
more energetically on the centers, causing greater 
wakefulness and greater stimulation of vasomotor 
and respiratory centers. 

Therapeutic doses of caffein increase the heart 
rate somewhat by acting directly on tlie muscula- 
ture; the force is changed but little, being slightly 
increased, resulting in an increased output in a 
unit of time; this, with the stimulation of the 
vasomotor center, causes a rise of blood pressure. 
The vasoconstriction at first may interfere with 
diuresis, despite the increased blood pressure, but 
the vasoconstriction is transient and in about 
twenty minutes it is succeeded by a slight dilation 
of the vessels of the kidney, while the general 
blood pressure remains a little above normal and 
the diuresis is increased. Cafl'ein is supjiosed to 
stimulate the renal epithelium, causing a consid- 
erable increase in the secretion of the watery part 
of the urine, but not so great an increase in the 
solid portion; hence the specific gravity of the 



DWRETICti AXD DIAPHOIiETICS. 3S1 

urine falls. Caffein is said to bring about a dila- 
tion of the vessels by a direct action on the walls. 

The effect of caffein on the psychic centers is a 
matter of common observation. Small doses re- 
sult in an increased capacity for mental work, 
particularly noticeable after the centers have had 
a short rest, as after a brief sleep. It lessens the 
feeling of fatigue and increases the capacity for 
physical work after a period of rest, Init not when 
it is taken during exhaustion or very severe 
fatigue. Tea and coffee owe their stimulating 
effects, in part, to the volatile oils which they con- 
tain and which are dissipated by boiling. 

Caffein is a constituent of tea, coffee, kola, and. 
more alnindantly (o per cent.), of guarana, wliieli 
is official. 

Caffein is not very soluble in water or alcohol, 
luit its solubility in water is greatly increased by 
such salts as potassium bromid and sodium ben- 
zoate or salicylate; this well-known fact has been 
appropriated as a "discovery" l)y manufacturers 
of certain nostrums. 

Caffein is most effective wlicn given in the iDnu 
of hot tea or coffee, tiic effect being heigblciu'd by 
certain volatile oils present and by tbe reflex stim- 
idation of the hot fluid in the stomach. Tea made 
by quick extraction contains but little tannin and 
ildcs not disturl) digestion to the same extent as 
that made by long contact of the water with t]i(> 
liMves. Caffein (and pai-ticniarly hot tea) is usc- 
fiil as an anlidotc to sikIi narcotic poisons as inor- 
phin and alc.linl. and it, is ;dso added to ilic anti- 
pyretics to lessen central dcincssion. 

]Jiiircsis serves to i-cmovc certain toxins which 



382 PHARMACOPEIA AND PHYSICIAN. 

arc excreted by the kidneys, and a copious watery 
diuresis may serve to lessen tlie action of such 
metals as mercury and lead. 

Diuretics are useful in dropsy, and, since the 
object is the removal of liquid, caffein, digitalis, 
theobromin and those which are used with but 
little water are to be preferred in such cases. 

Digitalis is used in the form of the tincture, or 
more frequently, perhaps, as an infusion. Caffein 
may be given in the form of hot tea or coffee. If 
the former made quickly, removed from the leaves 
and the clear infusion then boiled, the volatile oils 
are dissipated. This may be advantageous when it 
is desired to minimize the wakefulness which tea 
causes. One of the soluble forms of caffein sug- 
gested below may be used if preferred.- Theo- 
bromin may be given in the form of hot cocoa. 

When digitalis or other diuretics produce a 
more than temporary vasoconstriction in the kid- 
ney, one drop of the 1 per cent, solution of nitro- 
glycerin may be given at the same time. 

Caffein Sodio-Benzoate, N. F., and Caffein 
Sodio-Salicylate, N. F., consist of 50 per cent, of 
caffein, with sodium benzoate and sodium sali- 
cylate, respectively. 

Caffeina. — IT. S. P. — This is a feebly basic 
(alkaloidal) substance obtained from Thea sinen- 

2. The following mixture, to be varied according to needs, 
represents the method of using caffein in this soluble form : 
Caffein (allialoid) | 

Sodium salicylate, each 3i 4| 

Cinnamon water to make Siii 100 1 

Each teaspoonful contains about 0.2 gm. (3 grains) of 
caffein. Sodium benzoate or lithium salicylate or benzoate 
may be substituted for the sodium salicylate. This formula 
requires no unusual pharmaceutical skill to compound and 
the cost is very much less than that of the proprietaries used 
for the same purpose. 



DIURETICS AND DIAPHORETICS. 383 

sisj Coffea arahica or other plants. It does not 
form stable salts. 

Average dose: 0.05 gm. (5.0 mg. or 1 grain). 

The other soluble forms of caffein are : 

Caffeixa Citrata. — U. S. P. — This consists of 
equal parts of caffein and citric acid. 

Average dose: 0.1 gm. (2 grains). 

Caffeixa Citeata Effervescens.^U. S. P.— 
This contains 4 per cent, of citrated caffein. 

Average dose: 4 gm. (60 grains). 

Diuretin is a trade name applied to a mixture 
of theobromin-sodium and sodium salicylate, while 
agurin consists of theobromin-sodium and sodium 
acetate. Diuretin and agurin are decomposed on 
exposure to the air and become much less soluble. 

The official sugar of milk and the unofficial 
urea cause diuresis, probably by acting on the 
renal epithelium. 

Scoi'AUius. — U. S. P. — This is sometimes in- 
correctly classed with digitalis because it slows the 
heart, l)ut it weakens the beat, while digitalis 
strengthens it. The alkaloid, spartein, is respon- 
sible for the cardiac and vasoconstrictor effect of 
scoparius, but the diuretic effect is due to scoparin, 
a glucosid. 

Average dose (of sc()])arius) : 1 giii.( 15 grains). 

'I'he infusion or decoction is recommended foi- 
producing diuresis, except in dropsy.^ 

Sl'AKTEINyi: SULl'IIAS.— U. S. P.— While this is 
obtained from scoparius, it is not a true diuiclir. 

3. Soparhis I 

Potassium bitartrato, each Sss 151 

Tills qiiantlly of matorial Is to bo adtlotl to \ litor (1 
<inart) of wator, lii a suitable vessel, boiled for ten minntos. 
allowed to nool and strained. A wlneglassful of tbe resulting 
deeoitioii may be given every hour. 



;JS4 PHARMACOPEIA AND PHYSICIAN. 

and it is also of little or no value as a circulatory 
stimulant. 

Average dose: 0.01 gm. (1/5 grain), but this 
dose is sometimes considerably exceeded. 

IRRITANTS. 

Irritants which are excreted by the kidneys pro- 
duce diuresis, but, of course, they must not be used 
in greater amounts than are necessary to produce a 
mild stimulation. They are contraindicated in 
nephritis. 

The use of calomel in connection with scpiill and 
digitalis has been mentioned. It is most useful in 
cardiac dropsy and its use is to be stopped when 
the diuresis becomes free. It may be given in 
dose of 0.3 gm. (3 grains) daily, or in the form of 
Niemeyer's pills, combined with digitalis and 

squills. VOLATILE OILS. 

The irritants include a number of volatile oils 
which are much more frequently used for their an- 
tiseptic action on the urinary tract than for any 
slight increase in renal action which they may 
cause. They include such volatile oils as oil of 
turpentine and oil of juniper, which are more 
often used as diuretics than copaiba, cubeb and 
matico, which are employed mainly as antiseptics. 

IIEXAMETHYLENAMIK. 

The volatile oils have been largely superseded as 
urinary antiseptics by the now official hexamethyl- 
enamin.* 

4. The official name is very cumbersome, but no satis- 
factory substitute has thus far been suggested. Ilexamethyl- 
enamin was first brought before the profession by Schering 
Tinder the trade name of urotropin (Schering & Glatz), and 
it is still sold by them under this name. It is also on tlie 
market under various other trade names, such as formin 
aminoforni, cystogen and others. 



I 



DIURETICS ASD DIAPHORETICS. 385 

Hexamethylamixa. — U. S. P. — (Hexain- 
eth^'len tetramin). This is a condensation product 
produced by the union of fonnaldeh^'d and ammo- 
nia. While free from the irritating effect of 
formaldehyd, it yet retains its antiseptic proper- 
ties, the formaldehyd being gradually set free by 
dilute acids. Being an ammonium derivative, a 
solvent effect on uric acid has been claimed for it, 
just as for lithium salts. It is readily soluble in 
water and is best given in solution. 

Average dose: 0.2o gm. (4 grains). 

This substance has been introduced with some 
slight modification under various names: iisually 
the modification is only sufficient to enable the 
manufacturers to say tliat their product is not 
identical witli the official. For instance, helmitol 
is anhydromethylen citric acid with hexamethyl- 
enamin. Uriform euibraces two other drugs of 
minor importance. 'J'he official preparation may 
be considered at least equal to them, since it is not 
modified by any useless or inferior products, and 
its purity is easily insured by chemical tests. 

UVA URSI. 

Another drug of this class whicli has been the 
subject of much dispute is uva uisi. lis principal 
usefulness is ])robably in catarrhal conditions of 
tlie urinary tract. It contains a glucosid, arbulin, 
uliicli is dec(jmjjosed, ]jartly perhaps in the kidney, 
bill iii()r(,' abundantly in contact with catarrhal 
mucous membrane, hydrochinou, an antiseptic, be- 
ing formed. 

TTvA I^itsi. — U, S. P. — 'J'lie dried leaves of 
Anloslaj/lii/lus Ufa Ursi, of which the only official 
preparation is : 



38U PHARMACOPEIA AND PHYSICIAN. 

Fluidextractum UviE Ursi. — U. S. p. 

Average dose: 2 c.c. (30 minims). 

Infusion oi; uva ursi is made according to the 
general formula for infusions by pouring 1 liter 
(1 quart) of boiling water on 50 gm. (1 oz. 5 
dr.) of bruised uva ursi. 

The fluid extract or the infusion may be given 
alone three or four times daily. 

Chimaphila.— U. S. P. — The dried leaves of 
Chimaphila umheUata, commonly called pipsisse- 
wa. It was introduced in America by Dr. John S. 
Mitchell in 1803, and later into England. 

Its medicinal action closely resembles that of 
uva ursi, to which, however, chimaphila is in- 
ferior. 

Fluidextractum CniMAPHiLiE. — U. S. P. 

Average dose: 2 c.c. (30 minims). 

There remains to be considered an important 
class of substances which are used as diuretics, 
but they are so well known that only a very brief 
notice is needed here. 

SALINE DIURETICS. 

AVheu diffusible salts of the alkalies arc absorbed 
into the blood they increase the amount of fluid 
and thereby increase diuresis and diaphoresis. 

The acetates are converted into carbonates and 
thus diminish the acidity of the urine or even 
render it alkaline. 

AVhen the alkaline carbonates are given by the 
mouth they neutralize the gastric juice and inter- 
fere with digestion, but this does not occur witli 
the acetates and citrates. The sulphates are not 
readily absorl)ed from tlie alimentary canal and 



DIURETICS AXD DIAPHORETICS. 387 

usually they do not cause diuresis when given by 
the mouth. Potassium nitrate is a very effective 
diuretic, but it causes some gastric irritation. 

The official salts most commonly employed as 
diuretics are: 

POTASSII ACETAS. U. S. P. 

Average dose: 2 gm. (30 grains). 

POTASSII BlTARTllAS. — U. S. P. 

Average dose: 2 gm. (30 grains). 
Potass II Citras. — ^IJ. S. P. 
Average dose: 1 gm. (15 grains). 

POTASSII ISTlTRAS. — U. S. P. 

Average dose: 0.5 gm. (8 grains). 
SODII ACETAS. — U. S. P. 
Average dose: 1 gm. (15 grains). 
SODII ClTHAS. — U. S. P. 
Average dose: 1 gm. (15 grains). 

SALTS OF LITHIU.M. 

Fur dceadL'S litliia has been a favorite shibboleLh 
for that class of wonder-workers who essay to dis- 
solve uric acid from the hidden recesses of the 
buman body where they believe it to be the causa- 
tive factor in such widely varying conditions as 
iheumatism, epilepsy, pneumonia, Bright's dis- 
ease, migraine and aneurysm. 

These claims of Ibo nostrum-makers have re- 
sulted in a widespread belief tbat the salts of 
lithium, either in large or small quantities, serve 
as uric acid solvents of unusual potency. 

While it is not demonstrable that these salts 
have any advantages as diuretics over other corre- 
sponding salts of the alkali metals, they are, never- 
tlioloss. widely used, oven at the present time, and 



388 I'JIAirUACOPEIA AXD I'JIYSJCIAN. 

will no doubt continue to occupy a place in our 
materia medica for some time to come. 

It is more than sixty years since Lipowitz an- 
nounced that this salt favored the solution of uric 
acid. Since then the lithium salts have been 
widely used, especially in combination with purga- 
tives and diuretics, but there is no evidence that 
any benefits result from such combinations. 

The lithium salts are of comparatively little im- 
portance accoixling to the accepted authorities in 
tlierapeutics of to-day. 

The official preparations ol' litliiiiin arc: 

LiTiiii Cakjjonas. — U. 8. P. 

Average dose: 0.5 gm, (8 grains). 

LiTiiii CiTRAS. — U. S. P. — Is used for the same 
purposes and in the same dose as the carbonate. 

LiTHii CiTR.vs Effeevkscexs. — U. S. P. — Is a 
convenient form for administering the citrate. 

Average dose: 8 gm. (120 grains). 

LiTHii Salicylas. — U. S. P. 

Average dose: 1 gm. (15 grains). 

Lithium salicylate was made official in 1880 be- 
cause of its asserted superiority in the treatment of 
acute rheumatism ; it possesses no advantages over 
the other salicylates, but the nostrum-makers hav- 
ing seized on it while the first reports of its suc- 
cessful use were being circulated, they continue to 
make the most extravagant claims for it in their 
preparations. Cusliny specifically denies that this 
salt has any especial solvent action on uric acid in 
acute rheumatism. 

DIAPHORETICS. 

The metbods used for producing diaphoresis 
are analogous to those employed for diuresis, con- 



DIURETWH AND DIAPHORETICS. 389 

sisting in those which influence the circulation and 
those acting on the sweat glands; but, in addition, 
certain agents, notably solution of ammoniinn ace- 
tate, act on the sweat center. 

The circulation in the skin is readily influenced 
by the application of heat in numerous ways and 
by what amounts to the same thing, the preven- 
tion of its loss by an impervious cover, such as 
oiled silk, or by agents which cause dilation of the 
NX'Ssels of the skin, such as hot alcoholic drinks and 
spirit of nitrous ether. Everyone is familiar with 
tlic sweating of nausea, and, while any nauseant 
will cause diaphoresis, the only one which is gen- 
erally em|)loyed for tbis purpose is the powder of 
ijjecac and opium, tlic well-known Dover's powder. 
'J'he only official substance used for the purpose 
which directly stimulates the secretion of sweat is 
pilocarpus and its alkaloid, pilocarpin. They do 
not act on the secretory cells, as caffein does on the 
kidney, but by stimulation of the secretory nerves. 

Diaphoretics are employed to arrest "colds" in 
tlie early stage-.?, to aid in getting rid of fluid ac- 
cumulation, as in dropsy, and to a lesser extent for 
getting rid of secretions. Diaphoresis often serves 
to relieve the kidneys or to supplement their ac- 
tion. \"<'g('table infusions which cause diuresis 
will usually cause diaplioresis at tbe same time if 
the |ialiciii is kept warm and measures are taken 
lo iiici-casc ihc l)l<i()(l siipjily of tlie surface (rub- 
Itiug, juustard, etc.). 

For the arrest of "colds"' ncai-jy auytliing caus- 
ing sweating seems io be eU'eciive, biii tlio ])owder 
of ipecac and n|Miiiii enjoys a ])arli(idai- i-oputa- 
I ion. 



390 PHARMACOPEIA AND PHYSICIAN. 

Among the official substances that are more 
directly useful as diuretics we have: 

PuLvis Ipecacuanha^ et Opii. — U. S. P. — 
Powder of Ipecac and Opium (Dover's Powder) 
contains 10 per cent.^, each, of ipecac, powdered, 
and powdered opium. 

Average dose: 0.500 gm. (7^ grains). 

PULVIS MoRPHINiE COMPOSITUS. — U. S. P.— 

Compound powder of morphin, also known as 
Tully's powder, containing 1.5 per cent, of mor- 
phin and 32 per cent, of camphor, has also been 
recommended, and is sometimes used, as a diapho- 
retic, in place of the older and more popular 
Dover's powder. 

Average dose: 0.500 gm. (7I/2 grains). 

Potassium citrate, referred to as a diuretic, is 
much used for its diaphoretic effect, particularly 
in the form of: 

Liquor Potassii Citratis. — U. S. P. — This is 
an aqueous solution of potassium citrate, contain- 
ing about 8 per cent, of anhydrous potassium 
citrate. 

Average dose: 15 c.c.' (4 fluidrams). 

Spiritus ^theris Nitrosi. — U. S. P. — Sweet 
spirits of niter. This is a very generally popular 
diaphoretic which is also used as a diuretic in 
fevers. 

Average dose: 2 c.c. (30 minims). 

Liquor Ammonii Acetatis. — U. S. P. — The 
old-time spirit of Mindererus. 

Average dose: 15 c.c. (4 fluidrams). 

The only official drugs which have diaphoresis 
as their predominant therapeutic action are pilo- 
carpus and its alkaloid, pilocarpin. They are both 



DIURETICS AXD DIAPHORETICS. 391 

too well kno\\Ti to require very extended notice in 
this place. 

Pilocarpin augments the secretion of the sweat 
and salivar}^ glands and of the gastric mucous 
glands. It has much less influence on the secre- 
tion of milk, bile, pancreatic juice and urine. 

The watery constituent of the secretion is in- 
creased to a much greater extent than the solid 
portion is, but the latter are also notably affected. 
The seat of action is in the nerve endings, and it 
is antagonized by atropin. 

Therapeutic doses of pilocarpin are followed by 
sweating, which is first seen on the neck and face, 
and which lasts from three to five hours. Pilo- 
carpin is said to increase the rate of growth of 
hair, but it, like all other substances, is usually 
useless in case of baldness. Pilocarpin constricts 
tiie pupil by acting on the same structures which 
atropin affects, having Ijut very little effect on the 
central nervous system. 

Overdoses cause death by asphyxia, due to ex- 
cessive secretion by the glands of the respiratory 



Pilocarpin is the pliysiologic antagonist of atro- 
pin, not because of any diaphoretic action, but be- 
cause it stimulates the structures which atropin 
depresses. 

Pilocarpus. — U. S. P. — Pilocarpus or jabor- 
andi leaves contain, by assay, not less than 0.5 per 
cent, of alkaloids. 

Average dose: 2 gm. (30 gra/^s), given occa- 
sionally in the form of a 5 per cent, infusion, 
made according to the ofTiciMl general formula for 
that class of preparations. 



;J9-2 PHARMACOPEIA AXD PHYSICIAN. 

Fluidextractu^^i Pilocarpi. — U. S. P. — This 
is made with diluted alcohol and contains 0.4 per 
cent, of the alkaloids from pilocarpus. 

Average dose: 2 c.c. (30 minims). 

PiLOCARPix^ Hydrochloridum. — U. S. P., 
and 

Pilocarpine Nitras. — IT. S. P., are therapeu- 
tically identical. They are both very soluble in 
water. 

Average dose (cither): (i.Ol gm. (1 /(J grain). 



CHAPTER XVII. 

CATHAETICS. 

Calliartics are among tlie most ancient of all 
medicinal agents, rhubarb having been in use 
among the Chinese for more than fort3^-five cen- 
turies, and senna and aloes were also used in 
ancient times. 

'i'lie use of purgatives is so general that it is 
usually considered a safe and harmless course, 
even when it does no good. This is true in the 
vast majority of cases, but Dr. M. L. Harris has 
recently called attention to the abuse of cathartics 
in conditions where they are potent for much 
harm. Among these he mentions : Closure of the 
intestine, as l)y strangulated hernia; complete local 
intestinal paralysis; localized spasmodic constric- 
tion, which tends toward spontaneous cure, but 
demands opium rather than cathartics; appendici- 
tis and peritonitis, in wliicli it is agreed that irri- 
tant cathartics, at least, are contraindicated, what- 
ever the individual opinion may be in regard to 
tlio use of the salines. 

Among the possibilities for the direst harm it 
may be pointed out that when a portion of the in- 
testinal tract is paral^'j^ed, which may occur in 
l)t<)main poisoning, active cathartics might pro- 
duce intussuscoj)tion l)y driving the healthy con- 
tracted bowel into the paralyzed relaxed ])ortion. 

liaxatives, ])urgatives jiiid drnstics will bo con- 
sidered in this chaptei-. While these tlii-ee classes 



394 PHARMACOPEIA AND PHYSICIAN. 

arc usually recognized by clinicians, there is no 
sliarj) distinction to be drawn between tliem, as 
large doses of laxatives or small doses of drastics 
will act as purgatives. 

For convenience, rather than evident pharmaco- 
logic reasons, we classify cathartics as : Vegetable 
cathartics, depending for their action on anthra- 
cene derivatives; drastics, or the resin anhydrids; 
purgative oils; laxative sweet substances; saline 
purgatives; mercurials; bile and miscellaneous 
purgatives. 

THE ANTHRACENE DERIVATIVES. 

The graphic formula of anthracene will help to 
show the relationship existing between several of 
these derivatives. Anthracene (Ci^H^q) consists 
of three benzene rinses united thus : 



CH CH CH 




CH CO COH 


/ \ / \ / \ 
HC C C CH 




OHC C ^C CCHa 
OHC C C CH 


1 1 1 1 
HC C C CH 




CH CH CH 
Anthracene. 


Tri 


\ / \ / \ / 

CH CO CH 

-oxy-methyl-anthraquinone. 



If an atom of H in the anthracene group is re- 
placed by one of 0, the compound is called an- 
thraquinone or anthrachinone. Other atoms of 
H may then be replaced by OH and the compound 
is called oxyanthraquinone, a prefix to the oxy 
showing the number of such OH groups in the 
compound; thus the name tri-oxy-methyl-anthra- 
quinone indicates that four H atoms of anthra- 
quinone have been replaced, three by OH groups 
and one by a methyl group CH,. This compound 
is known as emodin. 

Emodin and related compounds are found in all 



CATHARTICS. 395 

the drugs which owe their activity to the anthra- 
cene derivatives, but the constitution of emodin 
may vary in the arrangement of the substituted 
OH groups in different plants. ISTatal aloes con- 
tains no emodin or related compound; hence it is 
not usually purgative -for man, but it is not found 
in commerce at the present time. Natal aloes is 
said to act as a purgative for man when the diet 
consists of meat. 

Other members of this group of cathartics con- 
tain otlier principles besides emodin, which are 
derived from tlie anthracene nucleus ; thus chryso- 
phanic acid, or di-oxy-methyl anthraquinone, is 
also found in rhubarb, senna, rumex and probably 
in frangula. The name indicates that there are 
but two OH groups instead of three, as in the case 
of emodin. 

Chrysoplianic acid is too irritant to be used 
alone as a cathartic. When drugs containing it 
are taken, it is absorl)ed too rapidly to exert its 
action and is excreted in the urine. 

After taking rhubarb or senna, the urine is col- 
ored yollowisb if acid, and purplish if alkaline. 

Many other substances, the chemistry of whicli 
is obscure, are found in the cathartic drugs. 

Preparations of the crude drugs contain colloidal 
matter which enhances the action of the pure 
|)rineiples, and they are, therefore, to be preferred 
(() tlie latter; a fact to be remembered wlien read- 
ing tlie circulars of tliosc nostrum makers who lay 
stress on their extraordinary facilities for supply- 
ing pure principles. 

'The drugs of the anthracene group are char- 
acterized by a mildly irritant action whereby they 



39G PHARMACOPEIA AND PHYSICIAN. 

usually purge in from 8 to 10 hours without pro- 
ducing inflammation; lience the}' are to be pre- 
ferred to the resin anhydrids in chronic constipa- 
tion, or when a strong irritant action is contrain- 
dicated. 

The seat of action is mainly in the large intes- 
tine, and defecation is usually attended with some 
colic pain, but the small intestine is also afFectecl, 
though little or no increase in intestinal secretion 
occurs. 

The delayed action is due to the fact that one or 
more compounds which cause the increased peris- 
talsis are slowly split off from the anthracene 
nucleus in the alkaline contents of the intestine. 
Many of these appear to be inactive in the absence 
of bile, which probably acts merely as a solvent; 
hence that substance or glycerin and soap are often 
added to the members of this group. 

Xumerous synthetic derivatives of anthracene 
have been proposed, but they are not so useful as 
the official drugs and as yet have not come into 
general use. 

Aloe. — U. S. P. — Aloes, including the Barlia- 
does, Curasao, and the Socotrine, is the inspissated 
juice obtained from the various species of aloe. It 
was known to the early Egyptians and Romans. 
One or the other of the various species of aloes is 
official in every pharmacopeia. Natal aloes is now 
interesting only from a scientific point of view. 

Average dose (of aloes) : 0.25 gm. (4 grains). 

Aloe Purificata. — ^U. S. P. — This was made 
official in 1860, because of the impurities present 
in Socotrine aloes, due to the crude method of col- 
lection. The dose is the same as that, of aloes. 



CATHARTICS. 397 

Aloixum. — U. S. P. — This is a neutral jirinci- 
ple, vai'ving in physical and chemical properties 
with the variety of aloes from which it is obtained. 
It does not fully represent the crude drug, medic- 
inally. 

Average dose: 0.0.^ gm. (1 grain). 

ExTRACTUii Aloes. — U. S. P. — This is the 
aqueous extract evaporated to dryness. 

Average dose: 0.12 gm. (3 grains). 

PiLULiE Aloes. — U. S. P. — Each pill contains 
0.13 gm. (2 grains) of purified aloes and an equal 
amount of soap. 

Average dose: 2 pills. 

Pilule Laxative: C'o.Mi'O.siT.i:. — U. S. P. — 
Each pill contains: Aloin, 0.013 gm. (1/5 grain) ; 
strychnin, 0.0005 gm. (1/125 grain) ; extract of 
belladonna, 0.008 gm. (Vs grain) ; ipecac, 0.004 
gm. (1/16 grain) ; and glycyrrhiza, 0.045 gm. (% 
grain). This is a substitute for the proprietary 
pills, which under a variety of names have at- 
tained a wide popularity. 

Average dose (laxative) : 1 pill. 

The other official preparations into which aloes 
enters are: Pills of Aloes and Iron, Pills of Aloes 
and Mastic (the well-known Lady Webster's Din- 
ner Pill), Pills of Aloes and Myrrh, Compound 
I 'ills of lihubarb. Vegetable Cathartic Pills (no 
(iilomcl), Compound Cathartic Pills, Tincture of 
Aloes, Tincture of Aloes and Myrrh, and Com- 
ixiund Tincture of Benzoin. T]\c last-named prej)- 
aration does not contain eiionuli aloes to make it 
useful as a laxative. 

Si:NN\."-r. S. p. — 'i'lie AlexaiKJi'ia (short) 
and tlie Tinnivelly. or Indian (long), senna aiv 



398 PHARMACOPEIA AND PHYSICIAN. 

included in tlic official title. One, or both, of these 
is official in every pharmacopeia. 

Average dose: 4 gm. (60 grains). 

Fluidextractum Senn^. — U. S. P. — This is 
now directed to be made by first removing the 
resin with strong alcohol and subsequently extract- 
ing the drug with diluted alcohol. 

Average dose: 2 c.c. (30 minims). 

Sykupus Senn^. — U. S. P. — Syrup of Senna 
is now a very much more acceptable preparation 
than was that of the previous Pharmacopeia, and 
the physician should see that his patient gets the 
better article when it is prescribed. 

It represents 25 per cent, of the fluidextract — 
from which the principle that causes griping has 
been removed with alcohol — -with oil of coriander 
to flavor. It supplies an excellent substitute for 
the nostrums which depend on senna for their 
activities, such as castoria and the various "fig 
syrups," so called. 

■ For children one or two teaspoonfuls given 
alone at bedtime act as a gentle laxative; twice 
as much may be given as a cathartic. For adults 
twice as much is given as to children. 

This preparation is not disagreeable to the taste, 
but, since children are usually averse to anything 
called medicine, it may be given in a little cocoa. 

Average dose (as .laxative for children) : 4 c.c. 
(1 fluidram). 

PULVIS GLYCYERHIZiE COMPOSITUS. — U. S. P. 

—This powder, previously mentioned, contains 18 

per cent, of senna. It is widely used as a laxative. 

CoNFECTio Senn"^. — U. S. P. — This represents 

10 per cent, of senna, with cassia fistula, tamarind. 



CATHARTICS. 399 

prune and fig. It is substantially the same as 
the well-kno^\Ti proprietary medicine "Tamar- 
ludien.-"' 

Average dose: 4 gm. (60 grains). 

InPUSUM SeNN^ COIIPOSITUM. — U. S. P. — 
Formerly known as "black draught" (not black 
drop). This represents 6 per cent, of senna, and 
12 per cent., each, of manna and magnesium sul- 
phate, flavored with oil of fennel. 

Average dose: 100 to 200 c.c. (3 to 6 fluid 
ounces) . 

The only other oflicial preparation containing 
senna is: The compound syrup of sarsaparilla, 
which is useful only as a vehicle. 

Eheum. — U. S. P. — Ehubarb is obtained in 
Thibet and China from sources still undetermined. 
This valuable drug has probably been in use longer 
than any other substance now used wholly as a 
medicine. 

Average dose: 1 gm. (15 grains). 

The official preparations of Ehubarb are so 
numerous that we shall merely enumerate them, 
most of them being too well known to require ex- 
tended notice. They are: The Extract, Fluid- 
extract, Compound Pills, Compound Powder, 
Syrup, Aromatic Syrup, Tincture and Aromatic 
Tincture. 

The average dose of either syrup is S c.c. (2 
fluidrams) ; of the tincture, 4 c.c. (1 fluid- 
ram) ; of the aromatic tincture, 2 c.c. (30 min- 
ims). 

EiiAMNUS PuHSiiiANA. — U. S. P. — Cascara Sa- 
grada, or "sacred bark," is directed to be gathered 
a year ])nfore being used. It was introdiiccfl into 



400 PHARMACOPEIA AND PHYSICIAN. 

medical practice in 1877, Init as a domestic rem- 
edy in habitual constipation it was in use some 
time before that date in the region to which it is 
indigenous — the Pacific slope. It is nowv official 
in a number of pharmacopeias. It is not given 
in substance. 

Fluidextractum Ehamni Purshian^. — U. S. 
P. — This is prepared with 40 per cent, alcohol. 

Average dose: 1 c.c. (15 minims). 

Fluidextractum Ehamni Purshian^ Aro- 
MATicuM. — U. S. P. — The crude drug contains a 
bitter acid principle which is neutralized in this 
preparation with magnesia, orange and glycyrrhiza 
being added to flavor and sweeten it. There is no 
special skill required in making this preparation, 
and any reputable pharmacist can make it equally 
as well as the manufacturers who put it on the 
market in the form of proprietary preparations. 

Average dose: 1 c.c. (15 minims). 

ExTRACTUM Ehamni Purshian^. — U. S. P. 

Average dose: 0.25 gm. (4 grains). 

Pills of aloes afford a convenient form of admin- 
istration, the soap furnishing the alkali needed for 
developing the activity of aloes. The pill acts 
slowly and causes considerable pelvic congestion; 
hence it is useful in inducing delayed menstrua- 
tion and increasing it if scanty. For the same 
reason it, more particularly than other members 
of the group, is contraindicated in fevers, preg- 
nancy and in inflammatory conditions of the pel- 
vic organs. Alone, it is not so useful in chronic 
constipation, but it is often added to other purga- 
tives. The compound cathartic pill is the most 
popular of these combinations. 



CATHARTICS. 401 

Bile ajDpears to increase the activity of aloes. 
and the formula given below is suggestive as a 
suitable form of ailministration : 

IJ. Aloes I 

Fel. bovis insp. | 

Siiponis afi. gr. XX 1|3 

M. Ft. pil. No. 15. 

Sig.: Three at a dose. 

Tliese may be coated with salol, to prevent their 
disintegration in the stomach. The coating is 
readily done by simply melting the salol in a shal- 
low tin vessel, into which the pills are then drop- 
ped, and the vessel twirled until the salol solidifies. 
This method of coating is also applical)le to otlier 
so-called enteric pills, which are intenrlod to dis- 
solve only in the intestine. 

The tincture of aloes is so bitter that it is 
rarely used internally, but it is sometimes applied 
to bed sores and other local affections. Aloin 
alone is not so effective as aloes, but it is ex- 
tremely popular in such combinations as the com- 
pound laxative pill, which acts mildly after about 
sixteen hours. 

Senna is one of the Ix'st of remedies for chronic 
constipation, as its wse does not entail a still 
greater tendency to that condition. It has the dis- 
advantage of a disagreeable taste and of causing 
griping, if used alone; this tendency is overcome 
by combinin;^- it with aromaiics. TIk^ coiifeetion 
is useful ff)r cbildrcii and in pi'cgiiaiu-y. Tiie milk 
of the nursing mother who takes senna may purge 
the child. The resin which causes gi-i|)ing may be 
removed by extracting tlie leaves \\ iib alcnliol willi- 
out serious loss of tlie catbnrtic |)iiii(i|)lc. the ulli- 



402 PHARMACOPEIA AND PHYSICIAN. 

cial fluidextract being made from senna which has 
been thus treated. 

The compound infusion or the confection may 
be used alone. The compound powder of glycyr- 
rhiza is an extremely popular laxative. 

Ehubarb is useful in constipation associated 
with indigestion and catarrh of the small intestine, 
but not in chronic constipation, as the tannin 
present tends to increase the trouble after a time. 
All of the preparations are useful, but the aro- 
matic syrup and the compound powder are prob- 
ably the most popular, being especially useful in 
the summer diarrhea of children. The extract, the 
fluidextract and rhubarb in powder are all useful 
laxatives. The compound pills are said to be more 
useful in the expulsion of gas and in chronic con- 
stipation. They are commonly given alone. The 
following has been much used, but it is largely 
empirical : 

I^. Extr. rhei 

Feni reducti, aa gr. Ix 

Arseni trioxidi 

Strychiiinse sulph., aii gr. i 06 

Quininag sulph gr. Ix 4 

To be made into 40 pills; one to be taken before each 
meal. 

Cascara sagrada is probably the most useful lax- 
ative in the materia medica for chronic constipa- 
tion. " IJnlike most of these remedies, which de- 
mand increasing doses, it improves the digestion, 
and the dose may be gradually diminished. Owing 
to the very disagreeable taste of the fluid extract, 
tlie aromatic fluid extract, or the extract, in pills 
or capsules, is to be preferred. 



CATHARTICS. 40:] 

THE AXHYDRID GROUP. 

The active principles in drugs of this group are 
resinous in character; their chemistry is obscure, 
but most of them are laio^\'n to be glucosids. 
They cause violent irritation and even death in 
excessive doses and are not commonly used alone as 
cathartics. Since they produce very watery stools, 
they are sometimes used in dropsy, or to sweep 
away parasites — for instance, after a narcotic tcui- 
fuge, such as aspidium. 

The drastics in small doses stimulate peristalsis, 
and in large doses give rise to inflammatory con- 
ditions of the intestine, with serous or bloody diar- 
rhea. 

They seem to be inactive in the absence of bile, 
which acts as a solvent for them as in the case of 
the members of the anthracene group. They in- 
duce increased peristalsis of the small intestine 
particularly, and evacuation is not usually at- 
tended with colic pains except in the case of colo- 
cynlh, which appears to resemble the members of 
tlie anthracene group in its mode of action. 
Though it, too, causes increased intestinal secre- 
tion. 

Purgation is usually induced in from 1 to 3 
hours. 

Jalapa. — U. S. P. — Jalap, the dried tuberous 
root of Exogonium piirga, gathered in the neigh- 
borhood of Jalapa, Mexico, whence its name. The 
drug was introduced into Europe about 1609 ; it is 
now official in all pliarmacopeias. The drug should 
contain not less than 8 per "cent, of total resin. 



401 PHAiniACOl'EI.l AND PHYSICIAN. 

hut not more tlian 1.5 per cent, of resin soluble in 
(tlier. 

Average close (in powder) : 1 gm. (15 grains). 

PuLVis Jalaps: Co:\rposiTus. — U. S. P. — This 
is a mixture of 35 parts of jalap and G5 parts of 
potassium bitartrate. 

Average dose: 2 gm. (30 grains). 

Eesina Jalaps.— U. S. P.— That part of the 
alcoholic extract which is insoluble in hot water. 

Average dose: 0.12 gm. (2 grains). 

CoLOCYNTHis. — U. S. P. — The peeled dried 
fruit of Citrullus Colocynthis, a species of cucum- 
l)er. As "Kolokynthis," this drug was described 
Ijy Dioscorides and appears to have been well 
known even before his time ; since then it has been 
in constant use. 

Average dose: 0.05 gm. (50 mg. or 1 grain). 

EXTRACTDM COLOCYNTHTDIS. — U. S. P. 

Average dose: 0.030 gm. (30 mg. or % grain). 

EXTEACTUM COLOCYNTHIDIS COMPOSITUM. — U. 

S. P. — Compound Extract of Colocynth is a mix- 
ture of IG parts of extract of colocynth, 50 parts 
of purified aloes, 6 j)arts of cardamom, 14 parts of 
resin of scammony, and 14 parts of soap. 
Average dose: 0.50 gm. (7I/2 grains). 

PiLUL.T: CATHARTIC.5i COMPOSITiE. — U. S. P. — 

Compound Cathartic Pills. Each contains : 

Comp. ext. of colocynth gr. iss 08 

Mild mercurous chloiid gr. i 06 

Eesin of jalap gr. Vs 02 

Gamboge gr. y^ 015 

Average Dose: 2 pills. 

PiLULJE Cathartic-e Yegetabiles. — U. S. 1*. 
— Vegetable cathartic pills. Each contains: 



CATHARTICS. 405 

Conip. ext. of colocynth gr. i 106 

Ext. of hvoscyannis gr. ss |03 

Resin of jalap gr. Vs 102 

Ext. of leptandra | 

Resin of podopliylluin. riri....gr. y^ |015 

Oil of peppermint m. Vg |00S 

Average Dose: 2 pills. 

ScAMMOXiu:\r. — U. S. P. — Scammon}', a gum- 
rosin obtained hy incising the living roots of Con- 
rolvuUis Scamiiionia, has been Imown and properly 
esteemed as an active cathartic for over 20 cen- 
turies. 

Average dose: 0.25 gni. (4 grains). 
Resina Scammoxit. — U. S. P. — Eesin of Scam- 
mony is that portion of the gum-resin that is 
soluble in alcohol, but insoluljle in water. 
Average dose: 0.2 gm. (3 grains). 
PODOPHYLLU.M . — U. S. P. — Podophyllum, pop- 
uhirly known as mandrake root or May apple, is 
said to have been used by the American Indians, 
but the statement has been repeatedly questioned. 
Average dose: 0.5 gm. (714 grains). 

FlUIDEXTRACTUM PODOl'llYLLT. — U. S. P. 

Average dose: 0.5 c.c. (8 minims). 

Resixa Podophyllt. — U. S. P. 

Average dose (purgative) : 0.015 gm. (15 mg. 
or Vi gi'ain) ; (laxative): 0.005 gm. (5 mg. or 
1/10 grain). 

Lei'taxdua. — 1'. S. P. — Is raroly used in sub- 
stance. 

EXTRACTUM LEi'TAXDHiE. — U. S. P. 

Average dose : 0.25 gm, (-1 grains) . 

FLUIDEXTRACTUiE LePTAXDR.E. — U. S. P. 

Avei'age dose: 1 c.c. (15 minims). 



4()() PHARMACOPEIA AND PHYSICIAN. 

EuoxYMus. — IT. S. p. — Euonjanus is the dried 
bark of the root of Euonymus atropurpureus. 

The Extract (dose 0.12 gm. or 2 grains), and 
the Flnidextract (dose 0.5 c.c. or 8 minims) are 
also official. 

Elateeinum. — U. S. P. — Elaterin, a neutral 
principle obtained from elaterium, a substance 
deposited by the juice of the fruit of Echallmm 
Elaterium. 

Average dose: 0.005 gm. (5 mg. or 1/10 grain). 

Gambogia. — ^U. S. P. — Gamboge is a gum- 
resin obtained from Garcinia Hmiburii. 

Average dose: 0.12 gm. (2 grains). 

The therapeutics of the anhj^drid group may be 
treated together, as the action of the different mem- 
bers is very similar and there are few indications 
for one, rather than another, in a particular case. 

They are all used to some extent in dropsy, 
but elaterium is the most effective of all in the 
removal of water. They cause depression, and 
when this is severe it demands a stimulant. 

They are rarely used alone; thus scammony, 
which, in overdoses, has caused death, is used in 
the compound cathartic pill; jalap is often com- 
bined with calomel or with potassium bitartrate, 
in the compound jalap powder, which is adminis- 
tered alone. An example of the combination of 
calomel with jalap is the calomel and jalap pow- 
der of the iSTational Formulary, which consists of : 

Calomel gi 32| 

Jalap l\\ 64| 

The dose is about 1 gm. (15 grains), or a 
smaller amount may be given and repeated at in- 
tervals of several hours. 



CATHARTICS. 407 

Eesin of jalap is nearly tasteless and is, there- 
fore, often given to children ; it may be mixed with 
a little sugar for the purpose. 

Compound cathartic pills are so well known that 
they scarcely require further notice. The soap 
present (in compound extract of colocynth) slowly 
reduces the mercurous chlorid to the black oxid — 
increasing its effectiveness. 

Podophyllum has been called "vegetable calo- 
mel" and it was supposed to increase the secretion 
of bile, but this is not probable. It causes purga- 
tion after ten to twelve hours and is very useful in 
acute constipation. 

A suitable form of administration is suggested 
below, but the possible combinations are endless. 
The Triplex Pills (N. F.) have the following 
formula : 



Purified aloes gr. ii 

Mass of mercury gr. i 

Resin of podophyllum gr. 14 



12 
06 
015 



Dr. John W. Francis lias used a pill containing 
about 1 grain, each, of purified aloes, scammony 
and mass of mercury, with 1/20 minim of croton 
oil, I/4 minim of oil of caraway and enough tinc- 
ture of aloes and myrrh to make one pill. 

Lcptandra, euonymus and some other official 
vegetable drugs cause purgation, but do not re- 
(juirc special mention here. 

PURGATIVE OILS. 

There are but two of these which merit discus- 
sion here. Castor oil and croton oil owe their ac- 
tivities to two acids, ricinolcic in the castor oil, 
and crotonolf'ic in tlie croton oil. ^J'lio acid docs 
not exist uncoml)ined in castor oil, but is liberated 



408 PHARMACOPEIA AND PHYSICIAN. 

when it reaches the intestine, forming new com- 
pounds wliich are irritant and, therefore, purga- 
tive. 

Crotonoleic acid does exist free to a small extent 
in croton oil, which is, therefore, irritant even 
when applied to the skin. 

Other bland fixed oils are sometimes used as 
laxatives. Among those which are official are 
Olive Oil, Cotton Seed Oil, and Expressed Oil of 
Almond. 

Oleum Eicini. — U. S. P. — Castor Oil, ex- 
pressed from the seed of Ricinus communis, is a 
pale, yellowish or almost colorless, transparent, 
viscid liquid, having a faint mild odor, hut an 
offensive taste. It was known to the ancients, but 
fell into disuse; it was again brought into notice 
in 1764 by a West Indian physician, who described 
it as a gentle purgative. 

Average dose: 15 c.c. (4 fluidrams). 

Oleum TiCxLii.— U. S. P.— Croton Oil. A pale, 
brownish-yellow, fixed oil. expressed from the 
seeds of Croton Tiglium ; it has a slight fatty odor, 
and a mild, oily, afterward acrid and burning 
taste. (Great caution is necessary in tasting.) 

Average dose: 0.05 c.c. (1 minim). 

Castor oil is very useful in ordinary constipa- 
tion, and often in diarrhea, when it serves to re- 
move the irritating substance. 

Owing to the widespread repugnance to the taste 
of castor oil, many means have been devised for 
disguising it. If the mouth is merely rinsed with 
strong whisky, the oil may be swallowed without 
discomfort. For children it is given in the form of 
soda water with syrup of sarsaparilla, or with 



CATHARTICS. 409 

ginger ale, when it is often swallowed without tlie 
child's knowledge. 

The following formula is useful for disguising 
the taste : 

IJ. Spts. mentli. pii) Siiss 10| 

01. ricini q. s. ad siii 100| 

Sig. : 15 c.c. (4 fluidrams) to be taken without 
further dilution. 

Emulsions of castor oil have never been popular. 
as they but imperfect!}' disguise the taste. Soft 
capsules, containing 15 minims each, may l)c swal- 
lowed, and many persons find them unobjection- 
able. Three or four capsules are given at bedtime. 

Owing to its irritant character and the violence 
of its action, croton oil is not generally used as a 
purgative, but there are conditions in which it is 
very useful; it may be given in apoplexy, wlien 
the patient is unconscious, a drop being placed on 
the tongue either in the form of an emulsion or 
on sugar. It is useful when, from any cause, 
there is difficulty in administering a bulky ca- 
thartic, but it is contraindicated in inflamiuatovy 
conditions of the intestines. 

Croton oil is sometiiues applied to the skin as 
ail irritant. 

LAX.VTivE s\vei:t substaxces. 
Some of the following substances may be treated 
iiiider the subject of dietetics, since they are laxa- 
tive mainly because of tlic hiillc of non-absorbable 
matter. The dose is large and the action mild — 
with the exception of Cassia Fisliila. which is apt 
to cause griping: 



410 PHARMACOPEIA AND PHYSICIAN. 

Manna. — ^U. S. P. — The concrete saccharine ex- 
udation of Fraxinus ornus. It consists mainly of 
a peculiar sugar, mannite. 

Average dose: 16 gm. (240 grains). 

Prunum. — U. S. P. — Prune, the partly dried 
fruit. 

Tamaeindus. — U. S. P. — The prepared pulp of 
the fruit. 

Average dose: 15 gm. (% ounce). 

Ficus. — U. S. P. — The partially dried fruit. 

Cassia Fistula. — U. S. P. — The dried fruit. 
This and the three preceding articles enter into 
confection of senna. 

saline cathartics. 

The saline cathartics include the slightly absorb- 
able sulphates of sodium and magnesium, and cer- 
tain of the phosphates, tartrates and citrates. It 
will be convenient to discuss certain other laxa- 
tives, not usually classed as salines, under this 
heading. 

The cathartic salines are those which are slowly 
absorbed and, therefore, traverse the intestinal 
canal while containing a considerable amount of 
water, whereby the feces are kept soft and liquid. 

The salines have only a minor direct influence 
on peristalsis, but they increase it indirectly by 
means of the increased iluid which they retain. 

AVlien concentrated solutions are given, they 
absorb water until their concentration is equal to 
that of the blood serum; when dilute solutions are 
given water is more rapidly absorbed until the 
same degree of concentration is obtained, and then 
the solution is absorbed. 



CATHARTICS. 411 

Water and alkaline solutions leave the stomach 
rapidly in the absence of digestive activity and 
salines are given, preferabl)', before breakfast, as 
they then cause little or no nausea and are active 
in small amounts. 

If a concentrated solution is given during diges- 
tion it passes slowly into the intestine, and mod- 
erate doses may be absorbed without causing pur- 
gation. 

Failure to purge may follow the use of concen- 
trated solutions after a diet embracing only a small 
amount of water, as the blood is then more con- 
centrated and the saline solution is incapable of 
further concentrating it by the additional with- 
drawal of liquid; on the other hand, the saline is 
absorbed and is excreted by the kidneys, causing 
diuresis. 

As a certain amount of the saline is always ab- 
sorbed (often as high as 50 per cent, of sodium 
sulphate, much less of magnesium sulphate), diu- 
resis very frequently follows, especially after so- 
dium sulphate. The amount absorbed is quite 
variable, depending on the concentration of the 
solution, absorbability of the salt and other fac- 
tors. 

As a general routine it is better to administer 
the saline in fairly dilute solutions, as this spares 
the work of secretion necessary for diluting them 
in the stomach and intestine. 

Magnesium sulphate is converted into the in- 
soluble carbonate, at least in part, in the intestine, 
llio otlier salines are excreted unchanged. 

'J'lie purgative salts, in contrast to the antiquity 
of many of the vegetable cathartics, are of but 



412 PHARMACOPEIA A^ D PHYHICIAN. 

comparatively modern use, many of the inorganic 
salts being introduced into Europe by the Moors, 
but not coming into general use until after the 
tune of Paracelsus. 

Most of the purgative salts have a disagreeable, 
bitter taste, but Avhen taken in an efEervescing 
draught this bitterness is masked, and the efferves- 
cent salts have, therefore, come into great popular- 
ity. The widespread use of nostrums of this type, 
instead of the official effervescent salts prepared by 
the pharmacist, illustrates an unfortunate condi- 
tion which exists Avithout a sufficient reason. There 
is too much distrust of the pharmacist by certain 
physicians, who complain that pharmacists are un- 
able to supply preparations equal to those of the 
nostrum maker. This may possibly be true in 
isolated cases, but the proof to the contrary is fur- 
nished by the extreme simplicity of the prepara- 
tion of the effervescent salts which the average 
pharmacist can prepare quite as Avell as the large 
manufacturer. Nevertheless the nostrums of this 
class have an enormous sale. 

It is unfortunately true that the physician often 
lacks confidence in himself and prefers to use the 
ready-made mixtures rather than to exercise his 
own choice. This is degrading alike to medicine 
and to pharmacy. 

It is a part of our present purpose to illustrate 
the ease with which the physician may choose his 
own agents in the proportion which seems best 
adapted to each individual case, with the assurance 
that any honest pharmacist can compound his 
prescription in a form equal in efficiency and ele- 
o-ance to the nostrums. 



CATHARTICS. 413 

The preparation of tlie effervescent salts de- 
pends on the I'aet that tartaric and citric acids and 
sodinm ])icarbonate may be kept in contact with- 
out change when dr}', but unite with effervescence 
wlien they are dissolved in water. 

When Ave see how simple is the preparation of 
the various effervescent salts, and rememljer that 
the Pharmacopeia provides reasonably high stand- 
ards and readily applied tests for the purity of all 
official salts, with which all reputable manufactur- 
ers of chemicals comply, we see how alisurd is the 
pretense of the nostrum makers that they have 
special processes and peculiar facilities for manu- 
facturing products of superior quality. 

As an example of the ease with which efferves- 
cent salts are prepared, we give directions for mak- 
ing one. which, though extremely simple, is still 
the most complex of those which are official — The 
Effervescent Magnesiuin Sulphate. The same di- 
rections, with slight modifications, are used in pre- 
paring the other official granular effervescent salts 
and jnay be used when it is desired to include other 
salts or even caffein and similar substances. 

The magnesium sulpliate is dried over a water 
bath, powdered and mixed wilh powdered citric 
and tartaric acids, ilicii with llic sodium bicarbon- 
ate; the mixture is lieated to about 95° C. in a 
disli placed in an oven until it becomes moist ; it is 
then nibbcfl tlwough an ordinary tinned ii-oii sie\e 
(whicli ronii-; it into granules). These are then 
dried at a temperature of 54'' ('. 

Does it seem credible that any pliaiinacist is un- 
able to make so simple a prejiaration as that? 

Many of the nostrums that are offered to physi- 



414 PHARMACOPEIA AND PHYSICIAN. 

cians as effervescent saline mixtures are not even 
granulated, and some of them, at least, depend en- 
tirely on the use of the cheaper tartaric acid and 
sodium bicarbonate to produce effervescence. Mix- 
tures of this kind can be prepared extemporane- 
ously quite as readily as the frequently prescribed 
liquid preparations. 

Constipation is by far the most common com- 
plaint of those who live in cities. While the 
rational treatment consists in attention to the diet 
and other hygienic measures, for the most part, 
it is so much easier to read one of the innumer- 
alile advertisements which depict the terrible con- 
sequences of constipation, and the one certain 
means of escaj^e therefrom, that the credulous are 
all too frequently inclined to accept such state- 
ments as true. 

Any attempt merely to enumerate the nostrums 
of this type involves one in immediate difficulties, 
because of the enormous number of those adver- 
tised to the public, while those of this typo adver- 
tised to physicians are scarcely less numerous. 

The principal purgative salts and their indica- 
tions are so well known tliat we shall confine our- 
selves mainly to enumerating some of them, with 
suggestions for the forms in which they are avail- 
able, and a few of the combinations which may be 
found useful. We shall have occasion to contrast 
the well-known actions of these drugs with the 
absurd claims made for some of the nostrums 
which they compose. 

Magnesii Sulphas. — U. S. P. — Epsom Salt 
(by which name it is most widely known) is so 
called because it was formerly obtained by evajDor- 



CATHARTICS. 415 

ating the water of Epsom Springs. It is one of the 
chief constituents in many famous purgative 
waters, such, for instance, as the Hunyadi of Hun- 
gary. 

Average dose: 15 gm. (4 drams). 

Magxesii Sulphas Effervescexs. — U. S. P. 
— (Its preparation has heen detailed.) 

Average dose: 15 gm. (4 drams). 

Magxesii Carboxas. — IT. S. P. — A bulky, 
white, colorless and nearly tasteless powder, which 
is insolu1)le in ordinary solvents. 

Average dose: 3 gm. (45 grains). 

Magxesii Oxidum. — U. S. P. — This, commonly 
called magnesia, or calcined magnesia, closely re- 
seml)les the carlionate in its several properties. 

Average dose: 2 gm. (30 grains). 

Magxrsii Oxidum Poxderosum. — U. S. P. — 
This differs from the pi-eceding only in being more 
dense, and therefore requiring a less bulky dose. 
It was formerly known as Husband's, also as 
Henry's, magnesia. 

Average dose: 2 gm. (30 grains). 

Liquor Magxessi Citratis. — U. S. P. — This, 
almost always called "citrate of magnesia," is one 
1)1' the most agreeable of the purgative prepara- 
tions, but it does not keep well, and the freshly 
prejjared solution should therefore be ordered. 

Avci-aifc (lose (as piii'uai ivc) : .'KIO c.c. (diio l)ot- 
\U'). 

Magnesium carbonate is frequently employed as 
;in ant-acid; the oxids, light and heavy, are ant- 
acid and laxative. 'J'ho oxids should be given with 
a hirge excess oi' water. They are much used for 
.liil.Iivn. 



416 PHARMACOPEIA AND ■PHY,'<IGIAN. 

PoTASsii ET SoDii Tartras.— TJ. S. P. — This is 
commonly called Rochelle Salt because it was first 
manufactured in the city of Eoclielle. It was dis- 
covered by a pharmacist named Seignette and is 
often called Seignette salt by the French. 

Average dose: 8 gm. (120 grains). 

PuLVis Epfervescens Compositus.— U. S. p. 
— Seidlitz powder is the form in which Eochelle 
salt is most often used. 

SoDii Phosphas.— IT. S. P.— This has come 
into very general use of late years in the treatment 
of chronic constipation, and it is popularly be- 
lieved to exert a special influence on the liver. It 
is soluble in about six parts of water. 

Average dose: 2 gm. (30 grains). 

SoDii Phosphas Efpervescens.— U. S. P.-— 
This is much more pleasant to take than the ordi- 
nary sodium phosphate, of which it contains 20 
per cent. 

Average dose: 8 gm. (120 grains). 

SoDiT Phosphatus Exsiccatus.— it. S. p. 

Average dose: 1 gm. (15 grains). 

A preparation so well known as sodium phos- 
phate requires little therapeutic notice, but we 
wish to offer some suggestions as to the form in 
which it is available. 

The effervescent salt leaves little to be desired 
when one wishes to employ it as a laxative, but it 
is not well adapted for use with hot water. 

We give below several examples of its combina- 
tion. In one of these lithium citrate is used. Of 
course, these combinations may be endlessly varied, 
using the dried magnesium sulphate, for instance, 
instead of the dried sodium phosphate. 



CATHARTICS. 417 

Caffein is often used with effervescing salts, and 
this or other similar substances may be incorpo- 
rated without materially changing the formulas. 

IJ. Lithii citratis Si 4| 

Sodii phosph Sviii 30 

Sodii bicarb 3x 40 

Aoidi tartaiici 3vi 25 

The dose of this is about 4 gm. (60 grains). 

For use with liot water the following extem- 
poraneously-prepared mixture is preferable to the 
official effervescent salt : 

R. Potassii bitart 3x 40 

Sodii bicarb 3v 20 

Sodii phosph. exsic 3x 40 

Tlic dose of this preparation is the same as that 
of tlie one preceding it. In case a more alkaline 
mixture is desired the amount of sodium bicarbon- 
ate may be slightly increased and the potassium 
bi tartrate correspondingly decreased. 

Liquor Sodii PiiosrHATis Compositus. — U. 
S. P. — One c.c. represents 1 gram of sodium phos- 
l)hate. 

Average dose: 8 c.c. (2 fluidrams). 

To make this solution, the Pharmacopeia directs 
Ibat 100 gm. of sodium phosphate and 4 gm. of 
sodium nitrate bo triturated together in a mortar 
wilii 13 gm. of citric acid until completely lique- 
fied, tlien sufficient water is to be added to make 
tbe product measure 100 c.c. 

Although this requires no more skill than the 
weighing of the salts, the Alta Chemical Company 
l)n'tenfls Ihat it thus secures "An Ideal Neive 
Tonic, Laxative, .Vnalgesic I Stimulant of Gland- 
ular Function, adjuvant to all organic remedies 
indicjifcd in ihc orgaiiisiii ! relieving Hepatic Con- 



418 PHARMACOPEIA AND PHYSICIAN. 

gestion, supporting Sexual Power, regulating both 
excretion and secretion on a normal physiologic 
basis !" 

Tlie indications enumerated need not be re- 
repeated in full, but as an example of the misrep- 
resentation practiced by this firm we quote the 
following: "Especially reliable as a painless cure 
for the Morphin Habit !" Eheumagon, consist- 
ing of sodium iodid and sodium phospliate, is "a 
specific in all cachetic diseases." 

Does this insolent company suppose that we are 
bereft of every vestige of intelligence when it per- 
sists in making such statements? 

It must be evident to the least observant that 
we are drifting far from the safe course in thera- 
peutics when men, who have not sufficient knowl- 
edge to avoid absurdities so glaring that they be- 
come apparent on the first appeal to reason, ex- 
ploit our profession and use us to dupe the public. 
Are we to continue in this degrading position or 
are wo to assert our independence and demand 
common sense, at least, from those who seek to 
serve us? The arrogance of the nostrum vendors 
under the cloak of servility is becoming insupport- 
able, and physicians should no longer tolerate such 
abuses. 

MERCURIALS. 

Despite the widespread use of the mercurials, 
their mode of action remains a problem. Some 
authorities assert that calomel must be contro- 
verted into the oxid, others that small amounts of 
the bichlorid are formed, and that this is the active 
agent. The effect on the organism is not less a 
matter of dispute; pharmacologists usually deny 



CATHARTICS. 41!) 

that it causes an increase of bile-flow, as experi- 
ments, made by careful observers, on both man 
and animals with biliary fistula, have failed to 
demonstrate any increase. Calomel acts as an an- 
tiseptic and the bile is thus protected from decom- 
position, while the increased peristalsis affortls less 
time for its absorption. Some of the older clin- 
icians, however, still hold to the theory that it 
really does increase the amount of bile secreted by 
the liver. However calomel may act, it is the best 
remedy we possess for that form of indigestion and 
constipation which is frequently called "bilious- 
ness." 

HYDKAiaiViiUM Cum Crkta. — U. S. P. — Gray 
Powder. — This contains 38 per cent, of mercury 
(metallic) mechanically mixed with clarified 
honey and prepared chalk. 

Average dose: 0.25 gm (4 grains). 

Massa UydkarCxYri.— U. S. P.— The well- 
known *"l)liic mass'' contains ;i;i per cent, of mor- 
curv (inclallir ) coiiiliincd witii glyrvi-rliiza. altlica, 
glycerin, and linncy of rose. 

Average (lose: o.-^-) gm- (J grains). 

Hydijaugvki Ciii.oi;ii)i;.M Mite. — U. S. P. — 
Calomel is required by the Pharmacopeia to con- 
tain at least 99.5 per cent, of pure mercurous 
chlorid. 

"^rhei-e is, perhaps, no drug which is better 
known llian calomel, and we can afford to give it 
space in inverse pro])ortion to its importance. 

Average dose (as a laxative) : 0.12 gni. (2 
grains). 

.Mercury and (dialk. .■(miinnidy callrd -r;iv |.n\v- 
iler. dues nut occasion so niiicli nausea as the other 



4-20 PHARMACOPEIA AND PHYSICIAN. 

iiicrciirials in eonmioii iiso, and is usually pre- 
rcrred for cliildren who suffer with indigestion and 
constipation with considerable intestinal putrefac- 
tion. 

Tlic inei'ciii-ials arc tonlraindicated in chronic 
condirions, such as tuhorciilosis. and in the latter 
months of pregnancy. Tlic iist' of calomel as a 
diuretic has been mentioned, and while Wood pro- 
nounces it useful in chronic parenchimatous 
nephritis, others maintain that it is injurious^ and 
Sollmann has recently suggested that great con- 
servatism should be exercised in its employment. 
At any rate, it should not be used merely for its 
purgative effect when nephritis exists, or only with 
great caution. 

SuLPTiuu Pkecipitatum. — U. S. P. — SuLriiuii 
SuBLi^EATDii. — TJ. S. p. — and Sulphur Lotum. 
U. S. P.— These are the three forms in which Sul- 
phur is now official. Either the sublimed or the 
washed may be used as a laxative. The sulphur is 
slowdy converted in the intestine into the sulphid 
of sodium only to a small extent, which stimulates 
peristalsis, while the greater part of the sulphur 
remains insoluble and acts mechanically — merely 
by its bulk. Washed sulphur is an ingredient of 
compound powder of glycyrrhiza. Precipitated 
sulpliur is a very fine powder, and consequently it 
is converted much more quickly into the sulphid 
of sodium, giving rise to irritation, hence it is not 
used as a laxative. 

Since many of the syiuploms resulting from in- 
digestion and constipation were formerly attrib- 
uted to a deficiency in the formation of bile, agents 
were soucrht which would increase its secretion. 



CATHARTICS. 421 

Many of the purgatives now in eonunon use were 
supposed to possess this property, but the only 
agent -whicli has been shown by experiment to in- 
crease tlie secretion notably is bile itself. 

Philip Shaffer recently gave a woman with 
biliary fistula al)out 20 gms. (5 drams) of the 
purified ox bile in three days, resulting in a notable 
increase of bile secretion. 

This can scarcely be considered as a stimulation 
of the liver to increased production of the bile, for 
it seems probaljle that the ingested bile was ab- 
sorbed and again excreted by the liver. Even 
though this function of the liver were increased 
there is no evidence that a corresponding increase 
in tlie other functions occurs. In any event the 
official dose of bile is too insignificant to exert 
any notable effect on the total amount for the 
twenty-four hours,- since a healthy adult normally 
secretes about 500 c.c. in tbat period. 

The patient's general condition seemed to Ijo l)iit 
little affected by the absence of bile from the in- 
testine, but fats were not so well borne as in a nor- 
mal person. This but confiruis the experience of 
other observers, and in this light cholagogues lose 
111 Hell (if their importance. 

The precise role played hy hilc licyoml the .split- 
ling of fats is still a moot point. 

Tn this connection.it may he niciiiioned that the 
iiiinci'al acids, particularly the diiiilc nitro-hydro- 
ililnric. Iiaxc hccii iiiii(h used ['i)\' their supposed 

practical \aliie. hiil ihey are iiseriil in many coii- 
dili..ns Inr uhi<-h n de|i,-i,.|i,-v of hilr is supposed 

lo he Ihr cause. 



422 PHARMACOPEIA AND PHYSICIAN. 

Fel Bovis.— TJ. S. p.— Tlie fresh bile of the ox 
is used only in the form of: 

Fel Bovis Puriftcatum. — U. S. P. — Its use 
has already been mentioned. 

Average dose : 0.5 gm. 

ATROPIX. 

The action of atropin in the intestine is still a 
matter of disjnite. It is well known that direct 
aiDplications to the serous surface inhibit reflex 
peristalsis, but it has been maintained that very 
small amounts in the lumen increase peristalsis. 
The seat of action is not kno^vn, but presumably 
it is on the musculature of the intestinal wall. It 
may be that it tends to lessen local constriction 
which would interfere with peristalsis; at any rate 
the addition of small amounts of atropin or, l)et- 
ter still, extract of belladonna, to some of the 
laxatives, as in the compound laxative pills, seems 
to be distinctly beneficial. 

PIIEXOLPHTIIALEIN. 

Phenolphtlialein is not official as a medicinal 
substance, but is mentioned in the Pharmacopeia, 
in the list of reagents and test solutions, as an indi- 
cator in acidimetry. 

It has attracted some attention of late as a laxa- 
tive. In combination with soap and salicylic acid 
it is being widely advertised under the name of 
"Probilin."! 

1. The proprietors of probilin quote Dr. W. Bauermeister 
of Brunswick, Germany, as autliority for the assertion that 
salicylic acid and sodium oleate are the most powerful 
cholagogues. This is not in accord with the generally ac- 
cepted opinion of therapeutists. The same authority states 
that he had the two drugs put up in pills containing 1% 



CATHARTICS. 423 

GLTCEEI^T. 

Glycerin U3I. — U. S. P. — Glycerin, or, as it is 
more properly designated, glycerol, is frequently 
used in place of the ordinary form of enema as a 
rectal injection for the purpose of producing a 
rapid evacuation of the content of the lower howel. 

For the usual form of glycerin injection from 
4 to 15 c.c. (1 to -i fluidrams) are diluted with an 
equal portion of water and injected with a rectal 
syringe. 

SupposiTOiiiA Glycerixi. — U. S. p. — Supposi- 
tories of glycerin are generally preferred to other 
forms of aduiinistering glycerin. As now of- 
ficial they contain approximately 3 grams (-io 
grains) each of glycerin gelatinized by means of 
a hard soap, made from stearic acid and sodium 
carbonate. 

AYliile there is considerable difference of opin- 
ion as to how gl3'cerin acts when used locally in 
the rectum, it is generally supposed that its action 
is in part mechanical and in part due to a peri- 
stalsis occasioned by the irritation of the mucous 
mciiil)i-anc of Uie rectum, produced l)y the hygro- 

graius of each, adding mpnthol and phenolphthalein as anal- 
ef/tics and to mildly stimulate intestinal activity. 

From a chemical examination of probilin pills, made for 
ilic I'oiincil on I'harmacy and Chemistry of the American 
Mcflical Association (Jour.. .1. M. .i., August 24, 1907, page 
Toiji. i( appears that the true composition of this prepara- 
tion difTors materially from the formula, as imhlishcd at 
that lime, and Is about as follows: 

IMicnolphtlialein. 0.008; sodium saliiylMlc. (i.(il: siMliiiin 
olcalc and fn-o oleic acid. 0.10: niciil Iml. iMii: niinsliiic. 
ii.ftOO; elnsling powder, 0.00.".. 

'riic dusling powdoi- appears to be iiiadr up of lyrcjpdijhiin. 
licorice and diarcoal. 

I'ndor date of Oct. ."., 1007, Messrs. Scliciinj,' and «;!i:l/, 
piililisli a revised formula for probilin. wliiili praidially 
agrees witli 1 in- analysis as given above. 



424 PHARMACOPEIA AND PHYt^IGIAN. 

scopic properties of the glycerin. Authorities gen- 
erally agree that while the occasional use of glyc- 
erin in the rectum is devoid of harm, that the per- 
sistent or the continued use is injurious to the 
mucous membrane of the rectum. 

TREx\TMENT OF CONSTIPATION". 

First in the treatment of constipation, for whicli 
purgatives are well-nigh universally employed, 
stands diet. By this means alone a very large pro- 
jDortion of cases of chronic constipation might be 
cured. It should contain a certain amount of in- 
digestible residue, contrary to popular belief, and 
if the patient, in addition to correcting the diet, 
takes a fair amount of exercise in the open air 
and goes regularly to stool, but little purgative 
medicine will be needed. It should be remem- 
bered that a glass of cold Avater, alone, taken on 
rising, will often act as a laxative. 

Such simple remedies should always be tried be- 
fore resorting to drugs in chronic constipation, 
since the habit of taking laxatives is easily formed, 
but not so easily abandoned. 

Hydragogue cathartics are sometimes used in 
dropsy and to afford relief for the kidney. 

The excessive development of bacterial poisons 
in the intestine and their absorption into the blood 
cause symptoms varying from mere lassitude to 
profound shock. Purgatives sweep the bacteria 
and their j)oisons from the canal. 

Diarrhea, due to the presence of irritating mat- 
ter, such as undigested and fermenting food^ is 
often promptly relieved by a saline purge. Saline 
purgatives are also useful in reducing fever, but 



CATHARTICS. 425 

they are not suited to cases of the asthenic tvpo, 
because of the exhaustion which they produce. 

The preparations of the crude vegetable cathar- 
tics are usually but slightly soluble in water and 
dilute acids, Init readily soluble in alkalies; they 
are, therefore, not absorbed from the stomach to 
any great extent, but, being soluble in the intes- 
tinal contents, they act by irritating the bowel. 
They are much slower than salines in their action, 
producing evacuation of the intestine usually only 
after from five to sixteen hours with moderate 
doses. These facts arc of much importance in 
choosing a purgative wlien there is inflammation 
of the intestine or other aljdominal organs, as well 
as in pregnancy, since the irritation of the more 
drastic cathartics, by extending to the gravid 
uterus, umy iiidiicc prciuattivo oxpulsi(in of the 
fetus. 



CHAPTEE XVIII. 

EMMENAG0C4UES AND ANTISPAJ^MODICS. 

Several groups of agents will be considered in 
this chapter, since each group scarcely deserves a 
separate chapter in tliis book. Not that many 
pages of medical literature have not been devoted 
to each subject, but because their importance is 
such that they should be especially studied in more 
comprehensive works. 

EMMENAGOGUES. 

l^mmenagogues are agents which stimulate the 
menstrual flow, if they are given at the menstrual 
period, and which act as ecbolics or oxytocics when 
given during pregnancy or at term. 

Drugs which are irritant to the gastrointestinal 
canal, such as aloes and the drastic purgatives, as 
well as quinin, castor oil and a number of other 
substances, are often given at term to induce labor. 
Heat in the form of hip baths and vaginal douches, 
and counterirritants, such as mustard, are useful 
as emmenagogues but not as ecbolics. 

Various volatile oils and cantharidin are fre- 
quently used with criminal intent, but these may 
cause death without expelling the fetus. 



Ergot is a fungus of very complex, and probably 
variable, composition which has thus far defied 
successful analysis. Active principles can be iso- 



EiIiIEXAGO(aES, AXTISPASMODICS. 427 

lated from ergot, in a pure state, onl}- with diffi- 
culty or not at all, and the constituents so far ex- 
amined are not ver}- stable. 

Of the numerous substances that have been iso- 
lated from ergot there are but three that have re- 
ceived widespread recognition. These are ergotinic 
acid, cornutin and sphacelotoxin. Even these are 
probably compounds or mixtures which differ 
somewhat in their behavior. Since they are gen- 
erally recognized as representing the activities of 
ergot their actions may I)e briefly considered. 

Ergotinic acid is a sa^wnin-liko substance wliidi 
is decomposed in the gastrointestinal canal, hence 
its action is merely local, being an irritant when 
the drug is given by the mouth. It is depressant 
to the nervous system when injected into the blood, 
and as it does not participate in the medicinal ac- 
tion of ergot, preparations of ergot intended for 
subcutaneous injection slioiild lie fi'ced from it. 

Cornutin is also, probably, a compound, but is 
usually spoken of as an alkaloid. Its action is al- 
most exclusively on the medulla, whether the prep- 
aration is injected or given by the mouth. The 
isolated principle causes a rise of blood pressure 
and increased peristaltic movement of the uterus. 
Robert attributes the power to cause gangrene to 
this substance, and latterly he suggested that it 
lielps to e.\])el tbe Ictus. Large doses of cornutin 
cause convulsions. 

.Sphacelotoxin is not stable, but in eerlain coui- 
binaiioiis it is fairly so. It causes constriction of 
I he Mood vessels and results fn gangrene in parts 
of certain aniuuds, as in ibe couib and wattles of 
the rooster. H\m-c tliis appears to be the active 



42S Pll.UniACOI'FAA AND PIIYf^ICIAN. 

Gcbolic principle of ergot, the action on the roost- 
er's comb and wattles affords an easy method of 
testing its physiologic activity. Ergot deteriorates 
very rapidly, and commercial preparations of it 
are, necessarily, very variable. A good prepara- 
tion, however, is much more stable than is the 
drug itself, hence preparations once tested may be 
depended on for a number of years. 

The physiologic test is so simple that any physi- 
cian may apply it, and the importance of having a 
relialjle preparation is so obvious that we give the 
method that is ordinarily followed in testing a 
fiuidextract of ergot. 

A rooster with a bright red comlj and wattles 
is chosen and 5 c.c. of the fiuidextract is injected 
subcutaneous! y, or it may be added to crumb of 
bread, made into a paste and pushed down the 
craw with the finger. Within an hour or more the 
tips of the comb and wattles are found to be much 
cooler than before the injection; the color changes 
from bright red to dark (venous) and may become 
black. The rooster may become drowsy and refuse 
food for a few days. If unsuccessful, the experi- 
ment should be repeated on another rooster before 
condemning the preparation, as some roosters are 
not susceptible. 

It is olwious that when ergot is taken by the 
stomach the systemic action is due to the cornutin 
and sphacelotoxin, of which the latter is probably 
much the more important. 

The use of ergot for internal hemorrhage, except 
from the uterus, is irrational so far as may be 
judged from pharmacologic experiments. "While 
the results of different investigators of ergot and 



EMMENAGOGUES, ANTISPASMODICS. 429 

its derivatives are far from uniform, many of the 
discrepancies that have been noted may be ex- 
plained by differences in the substances used, due 
eitlier to the method of preparation, natural de- 
terioration of the crude drug or to variations in 
normal constituents. It must also be remembered 
iliat many of the experiments tliat ai'c recorded 
wf'iv made l)y injecting the drug into the vein, 
wlierc'by tlic action of crgotinic acid is brought out 
more prominently, which is not the case with sub- 
cutaneous or inti'anuisciilni' injections or oral ad- 
ministration. 

Tliere can be little doubt that when ergot is 
administered, just after the head of the child 
emerges, its active constituents will be absorbed 
from the stomach and Avill tend to lessen the dan- 
ger from i^ostpartum hemorrbage by causing the 
uterus to contract firmly. 

The value of ergot as an ecbolic has been ques- 
tioned, and many careful obstetricians advise that 
it be given only after the expulsion of the placenta, 
lest the uterus contract firmly upon it and prevent 
extrusion. If tlie drug is given before the placenta 
is expelled, large doses at least must be avoided. 

Large doses, given in the early stages of labor, 
liave resulted in tonic contraction and rupture of 
tlie uterus. Quinin is a much safer drug to pro- 
duce strong uterine contractions, since tetanic con- 
traction does not follow its use. The results of 
did'crcnt investigators witb bydrastinin are con- 
(ra<lictory. ' 

\'ai-i<)iis inoilillcnlioiis nf llic olliciiil |»rc|);ii';i( ions 
of ergot have been put on tiic marled , l)ul it seems 
hardly necessary to reiterate thai any of these 



4.!(» I'llAh'UACOl'ElA AND PHYSICIAN. 

should l)e carefully tested rather than that we 
should rely too implicitly on the statements of the 
manufacturers, particularly when these are com- 
paratively unknown to the ])hysician. Some of the 
more reputable firms now test their fluidextract of 
ergot before sending it out, and while it must be 
admitted that this test is qualitative rather than 
quantitative, it does assure a reasonably safe guide 
for uniformity. 

Ergot and its preparations are official as 

Ergota. — U. S. P. — The sclerotium of Claviceps 
purpurea^ replacing the grain of rye. On account 
of the variable nature of the drug itself, particu- 
larly in the form of powder, it is now seldom used 
in this form. 

Average dose: 2 gms. (30 grains). 

ExTRACTUM ERC40T.E. — U. S. P. — This is really 
a purified extract and represents eight times its 
weight of the cnidc drug. It includes a small 
proportion of sodium chlorid and about 10 per 
cent., by weight, of glycerin. A somewhat similar 
preparation, without tlie glycerin, is known in 
England as "ergotin." 

Average dose : 0.25 gm. (4 grains) . 

Fluidextractum Eugot.t:. — TJ. S. P. — Fluid- 
extract of ergot is directed to be made with diluted 
alcohol containing 2 per cent, of acetic acid. 

Average dose: 2 c.c. (30 minims). 

YiNUM Eugot-t:. — U. S. P. — Wine of ergot, as 
now official, is a simple dilution of tweilty parts of 
fluidextract of ergot with a sufficient quantity of 
fortified white wine to make 100 parts. 

Average dose: 8 c.c. (2 lluidrams). 



EMMENAGOGUES, AyTIf<PASiIODICS. 431 

Of the mam- drugs that have been suggested as 
substitutes for ergot but two need be mentioned. 

Corn Smut, Ustilago, was at one time official 
in this country. Resembling ergot in origin, it 
was thought to have similar uses; clinical expe- 
rience, as well as jiharmacologic investigations, 
however, showed that it was sometimes c[uite inert. 

GossYPii Cortex. — TT. S. P. — The dried bark 
of the root of Gossi/pium lierhaceum was, formerh- 
at least, asserted to have uses similar to those of 
ergot. It has been shown to have little or no effect 
on animals, and more careful clinical observation 
will probably demonstrate that its further continu- 
ance as an official drug is not warranted. A fluid 
extract, formerly official, has been discontinued. 

The treatment of excessive menstruation de- 
mands the consideration of the underlying cause. 
It may be the result of anemia, in which case diet 
and the use of hematinics will prove useful, or 
general tonics may be required. 

The treatment of hysteria has long depended 
largely on a number of substances, usually classed 
as antispasmodics, that differ widely in composi- 
tion and agree mainly in possessing a disagreeable 
odor, to which Sollmann attributes their efficiency. 

Their pharmacologic action gives no clue to 
tlieir clinical use, but we must accept clinical ex- 
perience as having established their value It is 
in precisely sucl) coinlitions, wbci'c sciciitilic iiii'ili- 
cine must oFlcii cDiircss il<rir i^iioranl. llial the 
charlatan and the nnsl nim-iii;ikci- liml 1 licii- great- 
est oj)|)orlunilics. While ii miisl he cMiisidci'cd as 
I \l rciiicly iin|»i'()l);il)lc (h;it iiiiini-jint iinsciciil illc 
men sJKiuld solve invsleries which iiave hallleil tlie 



4:52 PHARMACOPEIA AND PHYSICIAN. 

most careful observers, even a superficial review of 
the following list of official substances will reveal 
them as being the active ingredients in a number 
of nostrums that have been widely used and are 
si ill ])o])ular with mcdicnl men as well as the laity. 

OF in (MAT. ANTISPASMODTCS. 

AsAF(KTTDA.— ir. S. P. — This drug has long 
been popular as a condiment and as a carminative. 
Its use as an antispasmodic is probal)ly of later 
origin. 

Average dose: 0.25 gin. (4 grains). 

The official preparations are: the pill, tincture 
and emulsion of asafetida, enumerated under stom- 
achics. 

SuMBUL. — U. S. P. — This drug, commonly 
known as musk root, consists of the dried rhizome 
and root of an undetermined plant, probably of 
the family Umhcllifera. 

Average dose: 2 gms (30 grains). 

Coming from Central Asia, the homo of the 
musk deer, and having an odor somewhat sugges- 
tive of musk, this drug was early seized upon by 
the manufacturers of nostrums as offering good 
points for commercial exploitation. Apart from 
its rather unpleasant odor, due to a volatile oil, 
a resin and a trace of valeric acid, this drug does 
not appear to offer any particular reasons for its 
continued popularity. 

The official preparations are : 

Fluidextractum Sumbul. — U. S. P. — This is 
made with a menstruum containing 75 per cent, of 
alcohol. 

Average dose: 2 c.c. (30 minims). 



EAIMENAGOGUES, A.YT/.S7U,VJ/0i>/C'.V. 433 

ExTKACTUM SuMBUL. — TJ. S. P. — Tliis is di- 
rected to be made by conccntratiug the fluidcxti-act. 

Average dose: 0.25 gm. (4 grains). 

ViBUifXUM OruLus. — U. S. P. — Aibunuim 
()[)ulus, or cramp bark, is another drug that lias 
been freely exploited by makers of proprietary rem- 
edies, by whom ridiculously incongruous properties 
have been claimed for it. Careful chemical exam- 
ination, on the part of a number of investigators, 
shows that it contains a bitter, somewhat resinous, 
principle and a trace of valeric acid. 

Average dose : 2 gms. (30 grains). 

The only official preparation is 

Fluidextractum ViBURisri Opuli. — U. S. P. — 
'J'his is directed to be made with a menstruum con- 
taining two parts of alcohol and one part of water. 

Average dose: 2 c.c. (30 minims). 

The National Formulary contains several prepa- 
rations of a complex nature, neither better nor 
worse than the numerous, more or less similar 
trade articles which are so widely advertised in 
medical as well as lay journals, and which tbey 
are designed to rejilace. One of these, the use of 
NS'hich is not recommended, is 

TiNCTUHA ViBURNI OrULI COMPOSITA. — N. V. 

— This represents in each average dose (4 c.c. = 1 
iluidram) 0.25 gm. (4 grains) each of viburnum 
opulus and dioscorea (wild yam) with scuttellaria 
and aromatics. 

ViBUKMU.\r pRiJNiFOLiuAr. — U. S. P. — This is 
ofTicially described as the dried bark of the root of 
Vihiinniiii pninifoliuiii or of Viburnum lentago. 
'I'bis drug has been exploited for the same pur- 



434 PHARMACOPEIA AND PHYSICIAN. 

poses and in mncli tlic Stune way as vilnirnum op- 
nlus. 

Average dose: 2 gms. (30 grains). 

Fluidextkactum Viburn^i Pruxifolij.— U. S. 
P. — This preparation, like tlie corresponding prep- 
aration of viburninii opulus, is made with a men- 
struum containing two parts of alcohol and one 
part of water. 

Average dose: 2 c.c. (30 minims). 
. Valeriana. — U. S. P.— Valerian, as now offi- 
cial, consists of the dried rhizome and roots of 
Valeriana officinalis. This drug has been in con- 
tinued use in Northern Europe for several cen- 
turies. In England it appears to have been used 
at one time as a condiment for "pliysicall broths 
and meats." 

Average dose: 2 gms. (30 grains). 

TiNCTURA Valerianae. — U. S. P. — This prepa- 
ration represents 20 per cent, of the crude drug in 
75 per cent, alcohol. 

Average dose: 4 c.c. (1 fluidram). 

TixcTURA Valerian.^ Ammoniata. — U. S. P. 
— The Ammoniated Tincture of Valerian repre- 
sents 20 per cent, of the crude drug extracted with 
aromatic spirit of ammonia. 

Average dose: 2 c.c. (30 minims). 

Fluidextractum Valerianae. — U. S. P. — ■ 
This is directed to be made with 75 per cent, alco- 
hol. 

Average dose: 2 c.c. (30 minims). 

ZiNCi Valeras. — U. S. P. — Zinc Valerate oc- 
curs as white, pearly scales, having the odor of 
valeric acid. It is but sparingly soluble in water 



EAIMENAGOGUES, AyTISPA,'iMODICS. 435 

or in alcohol and is preferably directed to be given 
in either pill or capsule. 

Average dose: 0.12 gm. (2 grains). 

Ammoxii Valekas. — U. S. P. — Ammonium 
A^alerate (or valerianate in former pharmacopeias) 
occurs as colorless or white, quadrangular plates 
having the characteristic odor of valeric acid. It 
is freely soluble in water and in alcohol. 

Average dose: 0.50 gm. (7^ grains). 

The National Formulary contains several for- 
mulas for liquid preparations of ammonium val- 
erate. The most popular of these is 

Elixir Ammonii Valeriaxatis. — K F. — The 
average dose (4 c.c. = 1 fiuidram) of this prepa- 
ration contains about 0.14 gm. (2 grains) of am- 
monium valerate in aromatic elixir colored red, 
with tinctura of cudbear. 



CHAP^rER XIX. 

PAHASITICIDPJS AND ANTIGONOR- 
RHEICS. 

It will be convenient to consider under this 
head, agents used for parasites other than bacteria, 
which infest the skin and intestines, together with 
a brief reference to the antigonorrheics. 

Cleanliness prevents nearly all hurtful skin par- 
asitism, and, as the greater number of skin affec- 
tions are commonly treated more advantageously 
by the specialist, all that we shall attempt to do 
is to call attention to several of the different 
classes of parasites that infest the human skin, and 
enumerate some of the official remedies that have 
been used with success in their treatment. 

Tinea sycosis, barbers itch, is one of a group of 
skin diseases due to a vegetable parasite, tri- 
cophi/ton tonsurans, which attacks the hair fol- 
licles. 

Scabies, or itch, is an animal parasitic disease, 
generally due to the common itch mite, Sarcopies 
scabies, though there are a number of other species 
of Acarida that occasionally infest the human skin. 

In the treatment of all skin diseases of para- 
sitic origin, cleanliness is a matter of prime im- 
portance as a preliminary to the treatment with 
parasiticides or antiseptics. Among the remedies 
that have been used for this type of affection we 
may enumerate : 



PAJiASITlCIDES, ANTIGOXORliHEICS. 437 

Sapo Mollis. — U. S. P. — The official soft soap 
is directed to be made by saponifying^ linseed oil 
Willi potassium liydvoxid. It is particularly effi- 
cient as a detergent and is frequently diixvled, 
with hot water, as a preliminary to the treatment 
of scabies with : 

Ungui:xtdm Sulphurls. — U. S. P. — This oint- 
ment contains 15 per cent, of washed suli^hur in 
benzoinated lard. Some practitioners jDrefer : 

UXGUEXTU.M SULPHURIS Co:\[POSITUM. — N^. F. 

— This is also known as Wilkinson's ointment and 
as Ilebra's itch ointment, and contains precipitated 
calcium carbonate, 10; sublimed sulphur, 15; oil 
of cade, 15; soft soap, 30, and lard, 30 parts. It 
is a fair representative of the composite type of 
ointment, used for scabies, and may be varied 
readily to suit the particular indications in any one 
case. 

Sulphur and sulphur-containing compounds are 
also used for various forms of vegetable parasites. 
Among tlie official sul)stanccs tliat are used in this 
way we have: 

SoDii TiiiosuLPirAS. — U. S. P., and: 

SODII SULPHIS. — U. S. P. 

These two substances are readily soluble in 
water and are usually employed in the form of a 
lotion containing approximately 10 per cent, of 
eitlier of the substances in aqueous solution. 

Mercurials are also used quite frequently in the 
treatment of skin affections of parasitic origin. 
Ill ;i(liliti(>ii In IIk; soluble salts of mercury, used 
ill liie loiiii of lotion, we have the widely used: 

UxfiUKXTU-M Hydrauoyri Ammoniatj. — U. S. 
p. — This ointment contains 10 per cent, of ammo- 



438 PHARMACOPEIA AND PHY>SICIAN. 

niated mercury in a mixture of white petrolatum 
and hydrous wool fat. 

The louse wliicli infests the head requires no 
medication, since it is easily removed with a fine 
comb and thorough washing with tar soap. The 
ointment of red mercuric oxid or red precipitate 
has been used as a popuUir domestic remedy, and 
the fluidextract of larkspur, or of stavesacre, may 
1)0 useful in many cases. 

The louse, Pediculus piihis^ which infests the 
genital regions is smaller and more difficult to 
remove mechanically. 

A dilute solution of mercuric chlorid (corrosive 
sublimate) is sometimes used and is very effective 
for this troublesome parasite. It should not be 
stronger than one to five hundred (2 grains to 2 
fluidounces or 0.1 gm. to 50 c.c), and this should 
be used cautiouusly. A less cleanly but very effi- 
cient remedy is mercurial ointment. 

A 20 per cent, tincture of staphisagria, or 
larkspur, diluted with water, bay rum, dilute alco- 
hol or soap liniment is much used in some parts of 
the country. 

Among the names of staphisagria A\'hich indicate 
its conunon use are semen staphidis pedicularis 
and liiusekorner. 

In lieu of the unofficial tincture the now offi- 
cial: 

FlUIDEXTE ACTUM STAPHISAGRIil']. — U. S. P. — ■ 

Diluted with from 8 to 10 parts of soap liniment, 
or of bay rum, will be found equally serviceable. 
It may be prescribed as follows : 



PARASITICIDES, AXTIGOyOIiliHEWS. 439 

B. Hydiarg. chlor. cor gr.i 105 

Fluidext. staphysagrite flSi 5 

Alcohol flSi 301 

Aqu£e rosaj, q. s. ad fl^iii lOOJ 

Misce. 

Sig. : Apply as a wash. 

This will be found to be elfective aud, of course, 
much more cleanly than the mercurial ointment 
which is very commonly used. 

It may not be amiss to call attention to the fact 
that carbolic ointment not only kills the trouble- 
some chigger, but also relieves the smarting which 
that parasite occasions, or which is more fre- 
(juently caused Ijy scratching the place where the 
parasite is embedded. 

ANTHELMINTICS. 

'J'lie term anthelmintic, jucaning literally 
against a Avorm, embraces vermifuges and tcnia- 
I'uges, which expel the round or tape worms, re- 
spectively, and vermicides and tenicides which kill 
them; but, as a matter of fact, the ])arasitcs are 
rarely killed before their expulsion. 

Kiichennieister attempted to establish a rational 
basis for the use of anthelmintics, more than fifty 
years ago, but his work, wbich was widely quoted 
for a long time, lias but little valiKj at present. 

'J'hc effects of a large mini her of vermifuges 
were studied by von Scliroeder, who found that 
ascaridcs are remarkably resistant to poison placed 
in tbe media with the parasites, which are to a 
certain extent able to resist absorption. These 
parasites are surrounded by a chitinous substance. 
Mild when tliat is not acted on by tbe agent tbe 
iiioulb is tbe ])rincipal means of ingress to tlieir 
liodics. Santonin, even in concentrated solution, 



440 PIIAR.MAVOl'EIA AND PHYHWIAN. 

\v;is round to l)0 liavmless to the parasite, which, 
liowcvcr, foimd it ol)jectionable and sought to es- 
cape from tlie solution containing it, the move- 
ments being particiihirly active; from tliis it woukl 
appear that santonin drives the round worm out of 
its normal habitat into the large intestine, from 
which it must Ije swept by purgation. 

Santonin is insoluble in neutral and acid media, 
hence it is not absorbed from the stomach, but it 
appears to be in part converted in the intestine 
into the sodium santoninate, which is soluble, and 
which undergoes absorption. This may give rise 
to such symptoms of poisoning as convulsions, 
vomiting and diarrhea. 

If any of the poison still remains in the stom- 
ach when toxic symptoms are observed, it should 
be evacuated, and rapidly acting purgatives, such 
as castor oil and the salines, may be used to hasten 
the elimination from the intestine. Purgatives 
of the anthracene group act too slowly, and drastics 
are too depressant to be useful in such cases. San- 
tonin is excreted in the urine; hence a rapidly 
acting diuretic, such as hot tea, may be of service. 
The urine is colored yellow (red if alkaline) after 
ordinary doses of santonin. 

Small doses of santonin give rise to what is 
commonly termed yellow vision; this is due to 
some peripheral action whereby white light ap- 
pears violet, then yellowish, but the media of the 
eye is not discolored. 

The statement that the presence of castor oil 
greatly increased the toxicity of santonin for 
worms arose from a mistake, and santonin is 
now usually given with calomel. Since it is not 



l'Mr\HITICIDE^, A\TIGOyORBHErCS. 441 

intended to be dissolved in the stomach, a com- 
pressed tablet or lozenge of calomel and santonin 
is to be preferred. For the same reason, when 
santonin is given to a child, with a little sugar, 
the two substances should be lightly nibbed to- 
gether without l)eing powdered. Sodium santonin- 
ate, which is solnl)l(\ should not he used. Ihere- 
fore, and \ci-v jjropcrly, it lias Ix-eii disinissod 
from tlic hitor editions of our I'liarmacopcia. 

The following arc among the now official sul)- 
stances that are useful as vermifuges: 

Saxtoxica. — 11. S. P. — Sanlonica or Levant 
worm seed, as it is frequently called, is officially 
described as the dried unexpanded flower heads of 
Artemisia pauciflora. It is now seldom employed 
as such, being generally displaced by : 

Santoninum. — U. S. P. — Santonin, the inner 
anhydride or lactone of santonic acid, obtained 
from santonica, Avas discovered in 1830, by two 
German apothecaries, quite independently of each 
other, Kahlcr in Diissehlorf. and Alms in Meck- 
lenburg. 

Average dose: 0.06 gm. (1 grain). 

Spigelia. — TJ. S. P. — Spigelia or pink root is 
Iho dried i-hizonic and roots of Spigelia niarilaii- 
clica. 

Average dose: 4 gm. (GO grains). 

Fluidkxtuactum Si'ioELTyi;. — IT. S. P. — 'J'his 
is made with dihited alcoliol and is tlic prepara- 
tion now generally uscil wIh'D Ihis drug is to be 
administered. 

Average dose : 1 cc (i lliiidrani). 

Olkum f'liKxoi'oDii. — U. S. P. — Oil of Cheno- 
podium is a volatile oil distilled from Chenopo- 



442 PHARMACOPEIA AND PHYRICIAN. 

dium anthelminticiim, iiioi'e popularly known as 
American wormseed. 

Average close: 0.2 c.c. (3 minims). 

Quassia. — U. 8. P. — 'J'hc wood of ricrasina ex- 
celsa, Jamaica quassia, or of Quassia amara, Sur- 
inam quassia, is more frequently used in the form 
of a decoction or an infusion, made in accordance 
with the general formulas for these several prep- 
arations. 

Average dose: 0.5 gm. (7^ grains). 

ExTEACTDM QuASSiiB. — U. S. P. — This is an 
aqueous extract and represents ten times the 
weight of the crude drug. 

Average dose: 0.06 gm. (1 grain), 

Fluidextractum Quassi.'E. — IT. S. P. — This is 
directed to be made with a mixture of three parts 
of alcohol and six parts of water. 

Average dose: 0.5 c.c. (8 minims). 

TiNCTURA QuASSKii.— IT. S. P.— TMs is a 20 
per cent, tincture and is made Avith 35 per cent, 
alcohol. 

Average dose: 2 c.c. (30 minims). 

The Ascaris lumhricoides^ or round v/orm, is 
a very common parasite in the small intestine of 
children particularly. The most useful remedy 
for this parasite is santonin; this has been given 
in a variety of methods. Some authorities recom- 
mend from one-half to one grain (0.02 to 0.05 
gm.) morning and evening during three days for 
a child and on the fourth day a purgative. This 
suggestion was evidently based on the supposition 
that the parasites were killed or injured and were 
then to be swept out, but since we know that this 
is not true, the method in vogue at the present 



PARASITICIDE.^, AXTIGOXORRHEICS. 443 

time is to combine santonin with a slowly acting 
purgative, siieli as calomel in small doses. The 
purgative should follow the santonin in a few 
hours at the latest. It should be remembered at 
all times that santonin is not an absolutely safe 
remedy and that it is far better to try a small dose 
and to repeat it in a few days if not effective than 
to give the maximum dose in the beginning. 

A lozenge containing half a grain (0.03 gm.) 
of santonin given morning and evening, to a child, 
for three days will usually be found effective. 
Twice this dose is used for an adult. 

If it is desired to give santonin in powders, it 
may be prescribed somewhat as follows: 

R. Santonini (cryst.) grs. iii 0|2 

Sacchari grs. xxx 2| 

M. Ft. in chart, No. vi div. 

Sig. : One powder night and morning, the last doso to 
be followed by a purgative. 

The purgative may consist of calomel or syi'up 
of senna, or, according to the more modern teach- 
ing, 1/6 grain (0.01 gm.) of calomel may be di- 
i-ected to be incorporated in each paper. The mix- 
ture should be dispensed in granular form and not 
finely powdered. Sauioiiin taken in this way has 
very little taste. 

While santonin is perhaps the most effective 
remedy wc have for ascaridcs, the fluidextract of 
spigelia has been recommended and is said to act 
somewhat like sanlonin. It is recommended that 
a laxative be given hefoiv (lie spigelia ami a piii'- 
gative some hours Inter, or the combination ol' |)ink 
root and senna, that was at one time (piile eoin- 
Mion, may b(( pi'el'erred. 



444 PHARMACOPEIA AND PEYmCIAN. 

Spigelia, however, has also given rise to toxic 
sj-mptoms in children. 

Oil of chenopodium, or oil of American worm- 
seed, has long enjoyed a certain reputation, par- 
ticularly as a household remedy, for round worms. 
It has a very disagreeable odor and taste. It may 
be given combined with castor oil, or from one to 
three drops may be mixed with sugar for a child. 

The thread worm or pin worm, Oxyuris vermic- 
ularis, infests the rectum and colon, and is often 
spoken of as the seat worm. 

The common anthelmintics, such as santonin, 
together with purgatives, are usually effective in 
removing them, but they sometimes prove very 
troublesome and difficult to dislodge. 

Injections of large amounts of watery infusions 
are often useful. Infusion of quassia enjoys an es- 
pecial reputation, it lessens the mucus secretion 
and probably increases the movements of the para- 
sites, which facilitates their . removal when the 
bowel is emptied. 

As suggested in connection with the official 
preparations of cjuassia, an aqueous infusion, the 
extract or even a correspondingly diluted fiuidex- 
tract may be used, with some promise of satisfac- 
tory results, in cases in which the infusion can not 
be readily obtained. 

Phenol has also been recommended, but the 
danger of absorption entirely precludes its com- 
mon use. 

Thjanol is sometimes used for a parasite which 
infests the duodenum, Anchylostomum duodenale, 
not uncommon in Itah', l)ut not often seen in this 
country. 



PARA.SITICIDES, AXTIGOXORRH EICS. 44.-) 

Osier rec-ommends tlie cold injection of a strong 
solution of common salt for children, repeated for 
ten days at least. The hips are elevated to favor 
the retention of the injection as long as possible. 

TENIAFUGES, 

Remedies nsed for tape worm are commonly 
spoken of as teniafuges, even though the parasite 
may belong to a genus other than Taenia, but, as a 
matter of fact, the Tcenia saginata, which is derived 
from beef, is very much more commonly found in 
the human intestine, while Tcenia solium from 
swine is met with much less frequently in man, 
and Bothriocephalus latus, though mentioned in all 
text-books, is extremely rare in this country and 
|)ractieally never originates here, hence it may be 
disregarded in this place. 

It should be remembered that the various agents 
used as teniafuges are not free from danger and 
should not be used until a diagnosis has been posi- 
tively made by the appearance in the feces of parts 
of the parasites or the eggs. 

Male fern, or the much more widely used oleo- 
rosin, which fully represents the rhizome, is said 
to be very much less efhcacious against the Tcenia 
than against the Bothriocephalus, while pelletierin, 
obtained from the bark of pomegranate root, is es- 
pecially efficacious against the Tania. If this be 
true we have but another example of our tendency 
to take everything originating in Germany as be- 
ing universally applicable, without exercising our 
<iwn judgment, for male fern has certainly enjoyed 
a greater popularity tlian the circumstances appear 
lo justify. On the other hand, its wide use in 



44(1 PHARMACOPEIA AND PHYSICIAN. 

northern Germany is more rational, since the 
Bothrioceplialus is very commonly found there in 
man. 

It was found by von Schroeder that one part of 
pelletierin in ten thousand parts of a solution con- 
taining 1 per cent, each of sodium chlorid and 
sodium carbonate, was very rapidly fatal to Twnia 
serraia and to Tcenia inermis, while much stronger 
solutions were practically harmless to round 
worms. 

Estimating the content of the human intestine 
at 200 c.c. after purgation, if only 0.3 gm. (3 
grains) of pelletierin escape absorption from the 
stomach and pass into the intestine, it would be 
present in the proportion of one part in one thou- 
sand of intestinal content, or ten times the concen- 
tration found necessary by von Schroeder. 

Pelletierin is but mildly toxic to man; hence it 
appears to be an almost ideal teniafuge or teni- 
cide. 

Kamala, whicli was formerly official, and is still 
used, acts as an intestinal irritant, causing purging 
and, therefore, requiring no subsequent purgative. 
It is said to be effective against tenia and is usually 
administered in substance, being given in doses of 
from 4 to 8 gm. (one to two drams). 

Kosotoxin, obtained from kousso, resembles male 
fern in its pharmacologic action, but is said to be 
efficacious against Topnia as well as against Both- 
rioceplialus. 

Aspidium, or male fern, has repeatedly given 
rise to toxic symptoms and death has occasionally 
followed its use. It is apparently inferior to pome- 



PARASITICIDES, AXTIGOXORRIIEICS. 447 

granate in the treatment of tenia, and there seems 
to be little reason for giving it the preference. 

Filicic acid was fonnerly regarded as the active 
principle; however, it seems that there are a num- 
ber of principles which share the action. 

Pumpkin seed enjoys some reputation as a tenia- 
fuge, but it is not often prescribed alone. It has, 
at least, the advantage of not being toxic to the 
patient. 

so:me official substances used as teniafuges. 

Aspidiu:m. — U. S. P. — Aspidium, or male fern, 
the dried rhizome of Dryopteris Filix-mos or of 
Dryopteris marginalis, was known to Dioscorides. 
and advocated by him as being an efficient remedy 
for tape worm, but fell into disuse and ^\■as subse- 
quently nearly forgotten until revived as a secret 
remedy, for the same parasite, about the middle of 
the eighteenth century. 

Average dose: 4 gm. (60 grains). 

Oleoresina Aspidii. — U. S. P. — Oleorcsin of 
.Vspidium is now directed to 1)C made with acetone. 
This preparation was first suggested by Pescliier of 
(Icnova, about 1835, and has gradually displaced 
the other preparations of male fern. 

Average dose: 2 gm. (30 grains). 

Granatum. — ^U. S. P. — Pomegranate, the l)ark 
of the stem and root of Punica Granatum , was 
also known to the ancients as a remedy for tape 
worm. It appears to have been completely for- 
gotten and was introduced into Europe from India 
during the fir-st decade of tlie nineteenth ((^utiiry, 

Average dose: 3 gm. (30 grains). 



448 PHARMACOPEIA AND PHYSICIAN. 

Fluidextractum Granati. — U. S. P. — Fluid- 
extract of Pomegranate is made with a men- 
struum of diluted alcohol containing 10 per cent, 
of glycerin. 

This is a new addition to the Pharmacopeia and 
lias not as yet been widely used. 

Average dose: 2 c.c. (30 minims). 

PELLETiERiNiE Taxxas. — U. S. P. — Pelleticrin 
Tannate is officially described as a mixture, in 
varying proportions, of the tannates of four alka- 
loids (punicin, iso-punicin, methyl-punicin and 
pseudo-punicin) obtained from Punica Granatum. 

Average dose: 0.25 gm. (4 grains). 

Cusso. — U. S. P. — Tvousso, also known as kosso, 
koso and Brayera, consists of the dried panicles of 
the pistillate flowers of Hagcnia abyssinica. It 
was discovered by Bruce, about 1768, but was not 
generally known as an anthelmintic until after 
Brayer, in 1822, published his observations on the 
use of the drug in Constantinople. Kousso is usu- 
ally administered in the form of an unstrained in- 
fusion, the object being to secure mechanical irri- 
tation by the hairs which are found on the flowers, 
but they probably play only a minor part in the ac- 
tion of the drug. 

Average dose: 16 gm. (240 grains). 

Pepo." — U. S. P.— Pepo, or pumpkin seed, the 
ripe seed of Cucurhita Pepo, is usually adminis- 
tered in the form of ground seed, deprived of the 
hull, or as an emulsion, prepared from the ground 
seed. 

Average dose: 30 gm. (1 ounce). 

The tannate of pelletierin, being slightly sol- 
uble, is preferred as a teniafuge, but it is some- 



PARASITICIDES, A^'TIGOyORRUEICS. 449 

what expensive, and the decoction of the root bark 
is, therefore, frequentl}^ directed. It has been sug- 
gested that the alkaloid, being volatile, is driven 
off in the process of boiling, but the loss in this 
way has proved to be unimportant. The fresh 
bark is much more efficacious than that which has 
been kept for some time. It is stated that the 
deterioration is due to chemical change that takes 
place in the alkaloid. 

As we have no means of knowing the Cjuality of 
the bark which will be used in making the decoc- 
tion, it is better to use the pelletierin tannate or to 
direct the preparation of the extract^ made ac- 
cording to a formula devised by von Schroeder to 
enaljle one to get a fairly uniform product regard- 
less of the quality of the bark used. 

About one gram or less of the extract, together 
with one or two grams of tannin, constitute the 
ordinary dose for tape worm. 

Pomegranate root bark contains a large amount 
of tannin, too much, in fact, considering the 
amount of bark required to yield the requisite 
amount of pelletierin, hence none has to be added 
to the decoction. So abundant is the tannin that 
it may cause vomiting and defeat the purpose for 
wliich the dose is given, hence the extract men- 
tioned has a decided advantage over the decoction. 

1. The ground bark Is exhausted by heating with water 
on a water bath for an hour, the decoction Is cooled, milk of 
lime Is added In excess, the mixture Altered, water being 
iidded to the precipitate to wash out the alltalold, the wash- 
ings added to the filtrate, the filtrate neutralized with dilute 
sulphuric acid and again filtered. It may be taken In this 
form, after adding about a gram of tanuin, or the neutral- 
ized filtrate may be evai)orated on a water bath until nearly 
solid, and then extracted with 70 per cent, alcohol; this is 
then filtered and subsequently evaporated to a dry extract 
wliich is approximately eiiual to pelletlerlu. 



450 PHARMACOPEIA AND PHYSICIAN. 

The following is the metliod of using pelletierin 
tannate, the extract described above, or the decoc- 
tion: Beginning in the evening the patitot takes 
a light meal, which should be exclusively of carbo- 
hydrates, and then a laxative; on the following 
morning, while fasting, he takes 0.4 to 0.5 gm. (6 
to 8 grains) of pelletierin tannate, or a corre- 
sponding amount of the extract or decoction, fol- 
lowed in half an hour or two hours by a brisk 
purgative, such as castor oil or syrup of senna. 

Of 33 cases treated in this way, the entire j)ara- 
site, including the head, was removed in 29 cases. 
Failure in some cases is to be attributed to the 
head being securely protected by the folds of the 
mucous membrane. 

It is somewhat significant that the many for- 
mulas which have acquired some reputation in the 
treatment of tape worm contain pomegranate 
bark. The following taken from Osier is almost 
identical with a formula which has been held as a 
proprietary by a southern firm for a great many 
years, among whose patrons it enjoys a consider- 
able reputation: 

IJ. Granati 3iv 15 

Peponis 5i 30 

Ergotae piilveris 3i 4 

Aquae bull f gx 300 

An infusion is directed to be made (a decoction 
is better) froui which is formed an emulsion, by 
adding 

Oleoresiiise aspidii 3i 4 

Olei tiglii mii 

Acacise, q. s. 

The oleoresin of aspidium may be given as an 
emulsion or in capsules, or it may be combined 



PARASITICIDES, ANTiaOXOIUx'UEICi^. 451 

with teniafiigeSj somewhat after the formuhi given 
above. 

Pumpkin seeds are harmless and may be given 
either in substance or in the form of a decoction, 
using an ounce or more of the bruised seed. 

Of the other official substances that have been 
used to assist in expelling tenia it will suffice to 
enumerate: ether, chloroform, rectified oil of tur- 
pentine, napthalen and thymol. These are all 
comparatively active drugs and must, therefore, 
be used with caution. 

ANTIGOXOERHEICS. 

The title antigonorrhcics would appear to sug- 
gest that we have medicaments that have a spe- 
cific action on gonorrhea, or the causative factor 
of that disease, instead of representing, as it really 
does, a somewhat meaningless array of substances 
that have been used more or loss ompiricallv as 
i-emedies for gonorrhea. 

The name gonorrhea should properly l)c re- 
served for the contagious inflamnuition of mucous 
membranes caused ]jy a specific organism, the 
gonococcus of Neisser. In an even more restricted 
sense it is now frequently applied to the specific 
inflammation caused by that micro-organism in 
the male urethra. 

Prior to the discovei-y of tlm goiiococeiis. l)v 
Xcisser, in 1870, tliere was probably no one coiii- 
iiion disease about whicli there existed sutb widdv 
varying theories and opinions, and certain it is 
tbat no known disease lias l)een so persistently and 
so widely maltreated. 

From the time of llic carlv (.recks and of tlie 



4ry2 PHARMACOPEIA AXD PHYSICIAN. 

Romans the treatment of gonorrhea appears to 
have been relegated to the incompetent, the char- 
latan and the quack, and it may be safeh' asserted 
that no one disease, with the possible exception of 
syphilis, has been the direct, or the indirect, cause 
of more misery, more suffering and more untimely 
deaths because of this neglect and maltreatment. 
Eecognizing the seriousness of the disorder, it 
would be futile to give suggestions for exhaustive 
treatment, and practically the only apology that 
we have to offer for introducing even a mention of 
the disease, and of some of the official remedies 
that may be of use in its treatment, is to be found 
in the fact that victims of this disorder are even 
now subjects for neglect and malpractice. Evi- 
dent proof of this can be found in almost any one 
of the daily papers which regularly advertise spe- 
cific cures for all forms and kinds of urethral dis- 
charges. 

The heinousncss of this practice, and the really 
far-reaching and serious consequences of the prac- 
tice in its ultimate results have not as yet been 
properly appreciated even by such members of the 
medical profession as should be more thoroughly 
well informed. This is, in a measure, evidenced 
by the recently published statement, made by a 
prominent genito-urinary specialist, that he fre- 
quently uses and recommends a popularly adver- 
tised nostrum, the manufacturers of v/hich delib- 
erately mislead the layman into believing that he 
can be cured in 48 hours. 

As suggested above, the treatment of gonorrhea 
is not by any means the simple procedure that 
might be wished for and even the differentiation 



PARAiHTWIDEH, AXTIGOXOBRHEIdi. 453 

of true gonorrhea from a non-specific inflamma- 
tion is one that requires more than ordinary skill 
and experience, and should, wherever possible, be 
entrusted to a safe and conscientious specialist, 
who not alone has the interest of the patient in 
mind, but who will also attempt, so far as in him 
lies, to prevent the spread of the infection b}^ im- 
pressing on the patient the advisability of observ- 
ing certain necessary rules of cleanliness, decency 
and abstinence. 

Using the name, gonorrhea, in its most re- 
stricted sense, as applying only to the specific 
urethritis in the male, we may consider this as a 
type, and recount some of the suggestions for 
treatment that have been made in connection 
with it. 

This type of gonorrhea is said to be acute, sub- 
acute, or chronic, according to the stage of the in- 
flammatory process, and it may involve the an- 
terior urethra alone or include, by continuitv, the 
posterior urethra. 

The generally accepted routine treatment is to 
use only a mild astringent and antiseptic local 
application for the first or acute stage, to supple- 
ment tliis with the internal use of diuretics, of a 
terebinth inatc or resinous nature, in the subacute 
or secondary stage, and to use more active astrin- 
gents and antiseptics as local applications in the 
chronic stage of the disease. 

It will be noted by this that wliat is usually I'e- 
I'erred to as an antigonorrheic is in reality, l)iit a 
diuretic, an antiseptic or an astringent. 

Of the several official drugs and preparations 
that have been found to be more particularly use- 



454 PHARMACOPEIA AND PHYSICIAN. 

fill in tliese several stages of the disease, we may 
enumerate : 

PoT.vssii Permanganas. — U. S. P. — This is 
recommended to be used, as an irrigation, in very 
dilute solutions (1-2000 to 1-6000). 

Argenti Nitras. — U. S. P. — This was formerly 
quite popular, in very dilute solutions, but has 
fallen into disuse and is now frequently substi- 
tuted by one or the other of the non-official so- 
called organic silver salts. These latter prepara- 
tions, while unduly numerous, are usually expen- 
sive and the more popular of them are inexpres- 
sibly filthy. 

A satisfactory and apparently efficient substi- 
tute for the several silver preparations has been 
found in silver iodid. Drs. Siter and Uhle- have 
reported a series of cases in which this preparation 
was used, in the form of an emulsion of the freshly 
prepared silver iodid, with excellent results. 

A preparation such as was used by Drs. Siter 
and Uhle may be prepared by any pharmacist, as 
follows : 

Argenti nitratis | 

Potassii iodidi, afi gr. xxxiii 2|2 

Mucilaginis chondri X. F f3vi 251 

AqufE dest., q. s. ad f^iii lOOJ 

M. Sig.: Use as an injection. 

The best method of preparing a finely divided 
precipitate is to dissolve the potassium iodid in all 
of the water and add the crystals of silver nitrate 
gradually, shaking well after each addition; when 
the silver nitrate is dissolved, add the mucilage 
and shake thoroughly once more. 

The resulting mixture Avill represent approxi- 

2. University of Pennsjivania Med. Bui; May, 190.j. 



PARASITICIDES, ANTIGOyORRHEICS. 455 

inately 3 per cent, of silver iodid. The strength 
may be increased or decreased as desired. If pre- 
pared in this Avay, the weaker mixtures will require 
a corresi^ondingly smaller amount of mucilage to 
hold the powder in suspension and mixtures below 
1 per cent, may be dispensed without the addition 
of any foreign material. 

Of the drugs that are frequently used for inter- 
nal administration in the second or sub-acute stage 
of the disease the Pharmacopeia includes, in the 
order of their present popularity : 

OLEUii Saxtali. — U. S. P. — Oil of Santal, or 
oil of sandalwood, is a volatile oil distilled from 
the wood of Santalum album. The Pharmacopeia 
directs that tliis oil contain not less than 90 per 
cent, of santal. This requirement is readily met 
l)y the better grades of oil of santal now on the 
market, so that there is little or no need to resort 
to proprietary specialties containing, or purport- 
ing to contain, true oil of santal. 

Average dose: 0.5 c.c. (8 minims). 

Copaiba. — U. S. P. — Copaiba, balsam of co- 
jKiiha, as it is more popularly called, is derived 
from one or more South American species of co- 
paiba. It was introduced into Europe by the Por- 
tuguese, during the latter half of the seventeenth 
century, and lias long enjoyed the reputation of 
being of especial use in connection with specific 
uretliritis in the male. 

.Vveragc dose: 1 c.c. (15 minims). 

Oleum CoPAiBiE. — U. S. P. — Oil of Copaiba is 
officially described as a vf)latiU' oil distilled from 
(•opail)a. 

Average dose: 0.5 c.c. (S minims). 



450 PHARMACOPEIA AND PHYSICIAN. 

Oleoresina Cdbeb^. — U. S. P. — Oleoresin of 
Ciibeb represents the alcohol soluble portion of the 
dried, unripe fruit of Piper Cubeha. 

Average dose: 0.5 gm. (7^2 grains). 

Oleum Cubebj?,. — U. S. P. — Oil of Cubeb is a 
volatile oil distilled from cubeb. 

Average dose: 0.5 c.c. (8 minims). 

Of the more active astringents that are used in 
the third, or chronic, stage of gonorrhea, in the 
male, and form such a prominent part in the treat- 
ment of the more common form of gonorrhea in 
the female, we may enumerate : 

ZiNCi Sulphas. — ^U. S. P. — Zinc Sulphate. 

ZiNCi Acetas. — U. S. P. — Zinc Acetate. 

ZiNci Chloridum. — U. S. P. — Zinc Chlorid. 

ZiNCI PHEivTOLSULPHON^AS. U. S. P. Zinc 

PhenolsuliDhonate. 

Plumbi Acetas. — U. S. P. 

Alumen. — U. S. P. 

AciDUM Tannicum. — U. S. P. — Tannic Acid. 

Argenti Kitras. — IT. S. P. — Silver Nitrate. 

BiSMUTHI SUBCARBONAS. U. S. P. 

BiSMUTHI SUBNITRAS. — U. S. P. 

These several astringents, with or without the 
addition of well-knoMTi antiseptics, such as boric 
acid, phenol, thymol, glycerin, and the several 
combinations or preparations of them, practically 
constitute all that is necessary in the treatment 
of the most persistent of the clironic forms of gon- 
orrhea. 



CHAPTER XX. 

SUBSTANCES USED AS VEHICLES. 

Of the several methods of administering medi- 
cines, for their general effect, the administration 
of liquids by mouth is undoubtedly the most im- 
portant, as well as the one most generally followed. 
This one fact alone will suffice as an apology for 
devoting a separate chapter to the consideration 
of substances used as vehicles. 

The great majority of physicians pay all too lit- 
tle attention to the art of rendering their prescrip- 
tions pleasing alike to the eye and to the palate. 
I']ven in medical schools, if the matter is consid- 
ered at all, it is usually deemed sufficient to in- 
struct the student to give the mixture a sweet 
taste, by the addition of syrup, or a distinctive 
aroma by the addition of one or the other official 
medicated water, ignoring entirely individual 
taste or the nature of the mixture. In the matter 
of appearance it is commonly considered quite 
sufficient to avoid the inky mixtures produced by 
the addition of iron compounds to preparations 
containing tannin or tannin-like substances. 

From the point of view of the patient it is safe 
to say tliat the appearance of a mixture is often of 
even greater importance than the taste, not alone 
in so far as it concerns the individual preference 
of the patient, but even to the extent of affecting 
the ingestion and the subsequent absorption of 
tlie medicine, since we know that the digestive se- 



45S PHARMACOPEIA AND PHYHIGIAN. 

eretions are stimulated by tempting looking sub- 
stances and are inhibited by those which appear 
disgusting. In the case of women and children 
the subjects of flavoring and coloring are of much 
more importance than with men. While the aver- 
age physician will, no doubt, rightly consider that 
this subject does not deserve very extensive study 
on his part, he must admit that the observance of 
a few easily acquired rules may well be worth re- 
membering. 

Unlike the question of ready-made formulas for 
a great variety of conditions demanding individ- 
ual consideration, there is no reason why flavoring 
and coloring should not be reduced to the very 
simplest forms and used as a routine whenever the 
mixture admits of it. 

AVlien considering a subject that is so far-reach- 
ing and varied as this must be, it will, of course, 
be evident that the discussion of the several mat- 
ters can not be taken up in detail, but must of ne- 
cessity be more in the nature of suggestions for ob- 
servation and study. With the wealth of material 
that is available, by the use of the official aro- 
matics and diluents, it should be a comparatively 
easy matter for a physician to become thoroughly 
familiar with the properties and possible uses of at 
least several of these preparations and by judicious 
combination to produce not alone a variety of mix- 
tures, but, also, to impart to them an individuality 
in which he may well take pride. 

Many of the comparatively tasteless substances 
require but the addition of some mildly aromatic 
solvent or diluent, such as the aromatic medicated 
waters. Substances that are more acrid, bitter or 



f<UBf>TAXCES V8ED AS VEHICLES. 459 

saline in taste may be masked by tbe addition of 
syrup to the aromatic, or by the addition of a prep- 
aration containing glycyrrhizin, like the now offi- 
cial elixir adjuvans. Xaiiseoiis bitters are best 
masked Avith strong aromatics and syrnp. The 
simple but persistent bitters, such as quinin and 
strychnin, are agreeably modified by such an aro- 
matic as tincture of sweet orange peel, wine and 
sufficient syrup or glycerin to suggest sweetness. 
As an example of such a preparation we may men- 
tion the bitter wine of iron, which will be appre- 
ciated if one will but taste this really elegant 
preparation. 

SIMPLE VEHICLES. 

The official substances that can be classed as 
simple vehicles are so thoroughly well known that 
it may be thought superfluous even to enumerate 
tbera. In the order of their importance thev are: 

Aqua.— U. S. P. 

Aqua Destillata. — U. S. P. 

Syrupus.— U. S. P. 

Glycerinum. — U. S. P. — Glycerin has been 
discussed and must be admitted to have medicinal 
<|iialities, but, largely on account of its properties 
as a solvent and because of its sweetish taste, it is 
rrcqucntly used as a vehicle in place of syrup. 

l^IEDICATED WATERS. 

Among tlie moi-e frequently used, and, therefore, 
the more readily available of tlie official diluents 
or vehicles, we class the aromatic, medicated wat- 
ers. They are particularly well adapted for dis- 
solving such comparatively mikl tasting substances 



4G0 PHARMACOPEIA AND PHYSICIAN. 

as potassium citrate, sodium benzoate, sodium sali- 
cylate, morphin sulphate and antipyrin. 

One of the most pleasant of these prepara- 
tions is : 

Aqua Amygdal.^] Amar.^. — U. S. P. — Bitter 
almond water. This contains about 0.1 per cent, 
of oil of bitter almond, and appears to be particu- 
larly adapted for use with sedative expectorants 
such as codein sulphate. 

Average dose: 4 c.c. (1 fluidram). 

The following are particularly well adapted for 
Tise with children: 

Aqua Anisi.- — U. S. P. — Anise Water and 

Aqua Fosniculi, — U. S. P. — Fennel Water. 
They contain about 0.3 per cent, of the respective 
volatile oils and have long been popular as correct- 
ives or diluents for medicines such as fev^r mix- 
tures and mild anti-diarrhea mixtures, designed 
j)rimarily for children. 

Average dose of either of the above: 16 c.c. (4 
fluidrams). 

Another aromatic water that has met with con- 
siderable use is: 

Aqua Cinnamomi. • — U. S. P. — Cinnamon 
Water also represents approximately 0.2 per cent, 
of the volatile oil and, as a flavor, is sometimes 
preferred. 

Average dose: 16 c.c. (4 fluidrams). 

By far the most popular of the aromatic waters 
are : 

Aqua Mentha Piperita. — U. S. P. — Pepper- 
mint Water and 

Aqua Mentha Viridis. — U. S. P. — Spearmint 
A\'ater. These, like the preceding, are simple solu- 



sriiSTAXrES USED As VEIIK'LKS. 4(;l 

lions of volatile oils in water and represent ap- 
proximately 0.2 per cent, of their respective vola- 
tile oils. 

Average dose of either: Ki c.c. (4: fluidrams). 

Peppermint water, or spearmint water, is partic- 
ularly well adapted for nsc with the mild alkalies, 
such as potassium l)icarhonate or sodium bicarbon- 
ate, or mixtures of these with other soluble salts. 

The efficiency of solutions of the alkaline bicar- 
bonates may be usually enhanced hy the addition 
of a simple bitter, such as tincture of nux vomica 
or tincture of calumba. 

Simple solutions, even such as contain a small 
addition of a bitter sul)stance, should be directed 
lo be filtered, as this adds materially to the appear- 
ance of the mixture and tlnis ciihaneos its palat- 
.ibility and eliiciency. 

When a vehicle having more pronounced char- 
acteristics is desired the official aromatic elixir will 
piobably serve to meet more possil)le indications 
tban any other preparation. It may itself be 
varied by the addition of ilic jluid cxti'act of gly- 
cyri'liiza, as in the official clixii' adjinans, or by the 
addition of one of tlie official spirits, syrups, aro- 
matic tinctures, medicated waters or simple wines. 

Aromatic elixir is particularly useful in coiiucc- 
lion with the 
loids. and -aU^ 
niids; with tl 
-•IVcct of the (■( 
siglit of. 

'I'hc followil 
will he f..iin.l t( 



■;( <d( 


salts 


of ire 




ho hitler 


dka- 


u i 


h the 


solnl 


Ic i 


•dids an.l 


hro- 


<■ h 


llcr. 1 


o\\c\( 


■r. 1 


he sliiiiuh 


tiiig 


)nta 


ncd al 


ohol 


sho 


idd nol l)e 


lost 




(■ anio 


il;- ih 


■ I'l 


■|iar;il ious 


that 


.) h. 


■ of us 


' in ( 


nllll 


■elioll will 


the 



402 PHARMACOPEIA AXD PHYSICIAN. 

possible modifications of the simple elixir or other 
desirable vehicles : 

Elixir Auomaticui\[.^TT. S. P. — Aromatic 
Elixir is practically a solution of a mixture of the 
oils of orange peel, lemon, coriander and anise in 
25 per cent, alcohol, containing about 38 per cent, 
of syrup. The i-esulting preparation is not alone 
strongly aromatic, but is also sufficiently dense to 
hold finely divided substances well in suspension, 
\\hile the alcohol content is not sufficient to Ije ob- 
jectionable in the ordinary doses. 

Elixir Adjuvans. — U. S. P. — Adjuvant elixir. 
This is a simple mixture of 12 parts of fluidextract 
of glycyrrhiza with 88 parts of aromatic elixir, 
and is particularly well adapted for masking acrid, 
bitter or saline materials. The contained giycyr- 
rhizin, not being soluble in acid solutions, the 
preparation is obviously not suited for use with 
diluted acids or acid salts. 

The official spirits that may be used as additions 
to aromatic elixirs or as correctives to other alco- 
holic or hydro-alcoholic solutions are : 

Spiritus Anisi. — IT. S. P. — Spirit of Anise 
contains 10 per cent, of oil of anise in alcohol. 

Average dose: 4 c.c. (1 fluidram). 

Spiritus Amygdalae Amar^. — IT. S. P. — 
Spirit of Bitter Almonds contains 10 per cent, of 
oil of bitter almond in alcohol, and is the most po- 
tent of the official spirits. It is markedly aromatic 
and a very small quantity usually suffices to im- 
part a distinctive almond odor and taste. 

Average dose: 0.5 c.c. (8 minims). 



i 



8UBf<TAyCE8 USED AS VEHICLES. 463 

Spiritus Cixxamomi — U. S. P. — Spirit of 
Cinnamon contains 10 j^er cent, of oil of cinna- 
mon. 

Average dose : 2 e.c. (30 minims). 

Spiritus Gadltiieri.i:.— U. S. P. — Si^irit of 
Gaultheria is a useful jDreparation for cases in 
whicli the patient appears to have a predilection 
for teaberry or wintergreen. This preparation im- 
parts a distinctive odor and taste and should be 
used with discretion, as it appears to be objection- 
able to many people. It represents 10 per cent, of 
oil of gaultheria. 

Average dose: 2 c.c. (30 minims). 

Spiritus Mentha Piperit.i. — U. S. P. — 
Spirit of Peppermint and 

Spiritus Mentii.-e Viridus. — U. S. P. — Spirit 
of Spearmint, in addition to containing 10 per 
cent, of the respective volatile oils also represent 
tlie alcohol-soluble portion of 1 per cent, of the re- 
spective dry crude drug, whicli imparts to them a 
distinctive yellowish-green color. 

Average dose (either) : 2 c.c. (30 minims). 

The aromatic tinctures that are particiihii'iy 
useful for adding distinctive c-luirac-lci'islics lo 
li(|iii(l mixtures are: 

Tinctura Aurantii Dulcis. — U. S. P. — Tine- 
lurc of Sweet Orange Peel. This preparation is 
directed to be made from fresli peel and represents 
aj)proximately 50 per oouf. of the crude drug. It 
is a delicate l)ut clliciciil .■irnniiil ic ami is usi'ful in 
connection willi any ol' the liydro-alcnlioljc mix- 
tures. 

Average doso: -l c.c. (1 lluiilram). 



404 PHARMACOPEIA AM' I'llYSlCIAN. 

TixcTURA LiMONis CoRTicis. — U. S. P. — This 
is made from fresh lemon peel and. hy some, is 
preferred to orange. 

TiJs^CTURA Cardamom I.— U. S. P.— Tincture of 
Cardamom represents 20 per cent, of cardamom 
in diluted alcohol. 

Average dose: 4 c.c. (1 fluidram). 
TiNCTURA Cardamomi Composita. — U. S. P. 
Compound Tincture of Cardamom represents 2.5 
parts each of cardamom and Saigon cinnamon, 1 
part of caraway, 0.5 parts of cochineal and 5 parts 
of glycerin in sufficient diluted alcohol to make 
100 parts. 

Average dose: 4 c.c. (1 fluidram). 
TiNCTURA Lavandulae Composita.— TJ. S. P. 
Compound Tincture of Lavender consists of a mix- 
ture of 0.8 parts of oil of lavender flowers and 0.2 
parts of oif of rosemary in 75 per cent, alcohol, 
which is used to exhaust 2 parts of Saigon cinna- 
mon, 0.5 parts of cloves, 1 part of nutmeg and 1 
part of red saunders. 

The possible uses of tliis preparation are prolv 
ahly best illustrated l)y the official solution of 
potassium arsenite, which is flavored and at the 
same time colored by the use of 3 per cent, of this 
tincture. 

Average dose: 3 c.c. (30 minims). 
TiNCTURA A^ANiLLiE.— T\ S. P.— Tincture of 
A^anilla represents 10 per cent, of vanilla in 65 per 
cent, alcohol and is sweetened hy the addition of 
20 per cent., by weight, of sugar. 
Tlie official simple wines are: 
YixuM Album.— IT. S. P.— White Wine. This 
is an alcoholic lifpiid. made l»y fermenting the 



Si'liSTA\<J:s LSED -4.S' VEHIVLES. 4(i.") 

Jiiier (jf I'resli grapes, the fruit of l'(7('.s' vinifcra, 
and usually contains about 10 per cent, of alcohol. 

White wine constitutes an excellent vehicle for a 
number of acrid or bitter substances^ and is par- 
ticularly useful as an addition to the official aro- 
matic elixir. If from 10 to 35 per cent, of white 
wine be added to aromatic elixir it will imi)art to 
the latter a distinctive and generally agreeable 
odor and taste. 

VixuM KuBRUM. — I'. S. P. — Ked Wine is an 
alcoholic liquid that is made by fermenting the 
juice of fresh, red-colored grapes, the fruit of VUix 
I'inifera, in the presence of their skins, and su In- 
jected to the usual cellar treatment for fining and 
aging. 

The official syrups that are generally well known 
or widely used as diluents, correctives or veliie-les 
are : 

SvitL-iTs Aciui Cri'KKi. — r. S. P. — Syrup of 
Citric Acid. This is a slightly acid syrup, flavored 
with tincture of fresh lemon peel, and is useful in 
connection with the arpieous solutions of the alka- 
line salts of organic acids, siuli as iioiassiuin ci- 
trate. 

Svm;iMis AuRAXTir. — U. S. P. — Syrup of 
Orange also contains a Ifacc of citric acid and has 
a pleasant acidulous lastc. h is rrc(|nciitlv u>c(l 
in i)lace of tlie syrup of citric aciil and is pivlcrrcd 
by many. 

One objection that may lie raised to botli of 
these official syrups is thai they contain citric 
acid and aiv. Ihci-cfniv. iiicoinpatihlc witli the car- 
honates and hicnrlMniatcs. Where a leinoii oi' 
oran-:-e flavor is desired, without the citi'ic acid, it 



4UG PHARMACOPEIA A.V/) PHYSICIAN. 

may be secured by adding about 1 per cent, of tlic 
corresponding tincture to simple syrup. 

SyRUPUS PrUNI VlRGmiAN^.. — IT. S. P. — 
Syrup of Wild Cherry, while it represents the 
aqueous extractive of 15 parts of wild cherry, is 
most largely used as a pleasant vehicle or as an 
addition to other diluents, particularly in connec- 
tion with expectorants. 

Average dose: 4 c.c. (1 fluidram). 

Syrupus Tolutanus. — U. S. P. — Syrup of 
Tolu represents the water-soluble portion of 5 per 
cent, of tincture of tolu, and, like the preceding, is 
frequently used as a corrective in mixtures that 
are designed for use as expectorants. 

Average dose: 16 c.c. (4 fiuidrams). 

Syrupus Sarsaparill^e Compositus. — U. S. 
P. — Compound Syrup of Sarsaparilla contains 
fluidextract of sarsaparilla, fiuidextract of glycyr- 
rliiza and fluidextract of senna, and is flavored 
with a mixture of the volatile oils of sassafras, 
anise and gaultheria. 

This preparation constitutes an interesting re- 
minder of the widespread use of sarsaparilla as a 
universal panacea almost a century ago, but it is 
now seldom used for any other purpose than as a 
vehicle. It is particularly useful for such acrid 
drugs as the soluble mercurial salts and the iodids 
and bromids. 

Average dose: 16 c.c. (4 fluidrams). 

For use with immiscible liquids, for making 
emulsions and for suspending insoluble powders 
in aqueous solutions it is an almost universal prac- 
tice to use the official mucilasres or .srums. 



SUBSTANCES USED AS VEHICLES. 4(>7 

McrciLAGO AcAci.ii. — U. S. P. — Mucilage of 
Acacia, containing 34 per cent, by weight of aca- 
cia, 33 per cent, of limewater and 33 per cent, of 
distilled water, is probably the best known of these 
several preparations. It has a very wide field of 
usefulness, but as acacia is precipitated by alcohol 
it is not useful in connection with strongly alco- 
liolic liquids. The presence of limewater may prove 
to be a disturbing factor in connection with solu- 
tions of the alkaloids, and here the mucilage may 
readily be substituted by the syrup. 

Syrupus Acacia. — U. S. P. — This represents 
1 parts of acacia in a moderately heavy syrup. 

MuciLAGO Tragacaxth.^. — U. S. P. — Mucilage 
of Tragacanth contains 6 parts of tragacanth, 18 
jiarts of glycerin and sufficient water to make 100 
parts. This preparation is particularly useful in 
connection with alcoholic liquids and is very widely 
u.sed for suspending the content of resinous tinc- 
tures in aqueous mixtures. 

Another preparation that is quite extensively 
used to mask acrid. Ijittcr or otherwise disagree- 
able drugs is the recently admitted 

ExTRACTUM Maltj.— U. S. P.— Extract of 
Malt occurs as a semi-solid extract, having the con- 
sistency of thick honey, and is itself considered to 
ite nutritive, tonic and laxative. Tt has been used 
(juitc extensively, particularly in connection with 
several widely used proprietary preparations, as a 
vehicle for cod-liver oil, cascara sagrada and the 
l)itter alkaloids like quinin and strychnin. 
Average dose: 16 c.c. (4 fluidrams). 



4(i8 I'll.lh'MACOl'KIA AM) I'fl VSICIAX. 

SUGGESTIVE COLORIN'G. 

The subject of coloring is a much simpler one 
than is that of flavoring, bnt it is of ahnost equal 
importance, if we are to judge ]n' the practices that 
have been followed by manufacturers of elegant 
proprietaries for upward of a quarter of a century. 

Coloring agents are primarily divided into such 
as are useful with alkaline and neutral substances 
and such as are useful with dilute solutions of the 
official acids and acid salts. 

For those of the first class, preparations con- 
taining carmin or cochineal, for red, and glycyr- 
rhizin for brown are readily available. For the so- 
lutions of acids and acid salts, however, neither of 
these substances would answer, as they are both 
precipitated by acids, and we have recourse, there- 
fore, to cudbear for the red and caramel for the 
brown. 

Taking the official aromatic elixir as a type, this 
may be colored a bright red by the addition of 
from 10 to 20 per cent, of the compound tincture 
of cardamom, containing cochineal, or it may be 
given an equally bright red color by the addition 
of 1 per cent, of the Tincture of Cudbear of the 
Xational Formulary. Cudbear is the source of 
the bright red color that is so common in pro- 
prietary preparations, and as cudbear itself has no 
known medicinal j^roperties, apart from the pleas- 
ing suggestiveness of the resulting preparation, we 
must naturally conclude that the manufacturers of 
proprietary preparations have succeeded in im- 
pressing not alone the patient, but, in inany cases 
at least, the physician also, by the judicious use o± 
pretty colors. 



.si'B.STAXCh'S i SED A,S VEHICLES. 4()!) 

The use of caramel (burnt sugar) is too well 
known to need further comment, apart from the 
fact that the Xational Formulary contains a for- 
mula for a compound tincture of cudbear, Tinc- 
tura Persionis Composita N". F., which contains 
10 per cent, of caramel and will be found useful 
when a bright brown j^reparation is desired. F]-om 
I to 5 per cent, will suffice to give a light to dark 
brown tint to a colorless fluid. 

A very pleasing golden-yellow mixture that a]j- 
pears to be fairly stable with either acid or alka- 
line, solutions may be obtained by adding 1 per 
cent, or even less of the now official tincture of 
Hydrastis. Tliis preparation, though made willi 
(j5 per cent, alcohol, mixes readily with the official 
elixir, but precipitates slightly when added to 
a([ueous solutions, and they should, therefore, be 
directed to be filtered before being disj^ensed. 

For alkaline or neutral solutions, either aipieous 
or alcoholic, a liright red eojor may he obtained hy 
the use of 1 per cent, of Li(|uor Coccineus, N". F., 
(•r from one-tenth to one-lifih this quantity of 
I i:pior Caruiini, ^^. F. 



INDEX. 

[Heavy-face figures indicate pages on which subjects 
are treated at greater length than on the other pages 
mentioned.] 



A. C. K. mixture, 254 
Acetanilid, 309, 310, 315, 317, 
318, 319, 320. 
group, 309. 
Acetates, 390. 
Acetate of lead, 191. 
.\cetates of sodium and p itas- 

Acetparaphenetidin, 315. 
Acetphenetidin, 315, 319. 
Acetum opii, 299. 

scillcB, 281. 
.\cid arsenous, 110. 

benzoic, 28. 

boric, 61, 63. 

chromic, 228. 

cinnamic, 28. 

crotonoleic, 408. 

ricinoleic, 407. 

tartaric, 414. 
Acidum arsenosum, 110. 

carbolicum, 28, 89, 250. 

hydriodicum dilutum, 138. 

hydrobromicum dilutum, 328. 

liydrochloricum, 40, 55, 76. 

hydrocyanicum dilutum, 243, 
287. 

hypophosphorosum, 118. 

nitricum, 227. 

pliosphoricum, 118. 

salicylicum, 57, 81, 87. 

tannicum, 180, 182, 184, 456. 
Aconite, 247, »C5, 

action of, 306. 
Aconitin, 235, 247, 249, 307. 

amorpluis, 30S. 
.\coru8 calamus, 148. 
Adeps lanx liydrosus, 229. 
Adjuvant eli.'cir, 462. 
Adrenalin, 199, 230, 371. 
iEther, 159, 301 . 
/TSthylis carbamas, 325 
Aifurin, 383. 

Albuminates, metallic, 180. 
Alcohol, 46, 203, 360. 

food value of, n7. 
Alitnontary canal, anti-sepsis of, 



Alkaline antiseptic tablet, 
Alkalinity of blood, 387. 
.'Mkaloid of suprarenal i 

19S, 236, 348. 
Alkaloids, precipitant of. 
Aloes, 396. 

and iron pills, 94. 
Aloinum, 397. 
Alteratives, 125. 
Alum, 193. 

as a gargle, 63. 
Alumen, 456. 
Aluminum sulphate, 193. 
American wormseed, 444. 
Amido-phenol, 3.13. 
Ammonol, 309, 314. 
Ammonia, 290. 
Ammoniated glycyrrliizin, 
.\nimonii bromidum, 328. 

carbonas, 309. 

chloridum, 283. 

lodidum, 139. 

salicylas, 87. 

valeras, 435. 
Ammonium acetate, 103. 

carbamate, 359. 

carbonate, 359. 

clilorid, 283, 559. 

preparations, 359. 
Amyl nitrite, 373. 
Amylene hydrate, 324. 
.\mylis nitris, 372. 
.Analgesics, 3J)1. 
Analgesin, 316. 
Anchytostoniam duodenale. 
Anemia, 102, 105, Jon, 113, 
Anesthesia, injccii<ins fiir 
235. 

intraspinous, injections 
241. 
Anesthetics, general, 252. 
Aneurism, 387. 

local, 234. 
.Vngina pectoris, 372, 374. 
Anhydromethylen citric 

385. 
Anilin, 312. 
Anise water, 400. 



63. 
:lan(]. 



445. 
, 114. 
local, 



J'llAh'MACO/'KIA AXD PHWSIVIAN. 



Aii.Klvncs, 284, 387. 
Aiitlicliiiintics, 439. 
Aiilhraecne, 304. 

derivatives, 3!J4. 
Aiidiniciuonc, 3'J4. 
Antifi'l)rin, 31.j. 
Aiitigonunheic-s, 430, 4.jl. 
Antikaiiinia, 309, 314. 
Antimony, 276, 278. 

and potassium tartrate, •22-J, 

Aiitipvrcties, 320. 

clitniistry of, 311. 
Antipyrin, 309, 316, 318, 460. 
.\ntisepsis, 47. 

intestinal, 68. 

of eye, 65. 

of mucous membranes, 61. 
.\ntisei)tic solution, 62. 
Antiseptics, 28. 

and disinfectants, local, 47. 

rliemieal, 32. 

internal, 68. 
Antiselitol, 54. 
AiKieyiinni, 342, 348. 
A)ioniorphin liydroelilorid, 270, 

Appendicitis, 154, 393. 
.Vqua, 4.59. 

anuiionise, 359. 

amygdala' aniara?, 460. 

anisi, 460. 

camphorK, 3.56. 

cliloroformi, 1.59. 

cinnamoni, 460. 

foeniculi, 460. 

liamanielidis, 204. 

liydrogenii dio.xidi, 41. 

mentlu-B piperitse, 150, 460. 

mentlire viridis, 460. 
.\rbutin, 385. 
.\rgenti nitras, 193, 225, 454, 456. 

nitras fusus, 225. 

nitras mitigatus, 225. 
Aristol, 53. 

.\ristoloeliia serpentaria, 149. 
.Vromatic elixir, 463. 
.Vromatics, 147. 
Arnica montana, 204. 
Arseni indidnni, 110. 

tiinxidmii. 11(1, 226. 
Arsenii'. 107, 22(.v. 

and zinc chlorid, 226. 

antidotes for, 99. 

official preparations of, 110. 

solutions of. 111. 

therapeutics of, 113. 

trioxid, HO, 113, 226. 
.\rsenous acid, 226. 

iodid, 110. 
.\rtemcsia panciflora, 441. 



.Arteriosclerosis, 373. 

Asafetida, 157, 432. 

.\sagr;ea ofBcinalis, 248, 370. 

.\scaridcs, 446. 

Ascaris lurnbricoides, 442. 

Aspidium, 446, 447. 

.Vstringents, 179. 

uses of, 181. 

metallic, 189. 
.\tropa belladonna, 244, 354. 
Atropin, 235, 244, 306, 354, 306. 

indications for, 353. 

sulphate, 244, 354. 
•\urantii amari cortex, 148. 
Bacillus putrificus, 70. 

typhosus, 75, 82. 
Bacteria, effect of bile on, 73. 

putrefactive, 73. 
Baking soda, 222. 
Baldness, 220, 221. 
Balsam of copaiba, 455. 

of Peru, 53, 58, 280. 

of tolu, 279. 
Barberry, 146. 
Basham's mixture, 90. 
Baths, 201, 211. 
Beebe's serum, 125. 
Belladonna liniment, 245. 

ointment, 244. 

plaster, 245. 
Benzanilid, 312. 
Benzin, 254. 

Benzoic acid, 28, 58, 23.''). 
Benzoinum, 280. 
Benzoyl ecgonin, 235. 
Berberis aquifolium, 146. 
Betanaphthol, 58, 77. 
Bichlorid of mercury, 59. 
Bile, 401, 433. 
Biliousness, 75, 419. 
Biniodid of mercury, 59. 
Bismuth, insoluble salts of, 
188, 189. 

subcarbonate, 190, 456. 

subnitrate, 78, 190, 456. 

subgallate, 190. 

snlisalic>-late, 19i>. 
Bitter almond water, 400. 
Bitters, 144. 

astringent, 148. 
Black mustard, 209. 
Blackberry root bark, 185. 
Blaud's pills, 95, 103. 
Blindness from wood alcohol, 203 
Blisters, 217. 
Bloodletting, 37.^. 
Bloodroot, 275. 
Blue mass, 128, 419. 

ointment, 60. 

stone, 192. 

vitriol, 38, 192, 225. 



IXDEX. 



Borax, 64. 

Boric acid, -13, 52. 57, 01, 03, 

196. 
Boron compound, 45. 
Bromidia, 304. 
Bothriocephalus latus, 445. 
Brand V, 205, 3«1. 
Bra vera, 448. 
Briglit's disease, 387. 
Bruniid group, 325. 

sodium and potassium, .323. 
Bromidia, 35411. 
Bromids, 309, 325. 

soluble, 461. 
Bromoform, 254. 
Bronchitis, l»f). 

acute, 271. 

chronic, 286. 
Brown coloring, 469. 

nii.xture, 290. 
Burgundy piteli, plasters of. 

208. 
Burns, CG. 

Butvl cliloral, hydrate, 324. 
Caffein, 317, 319, 352, 3.55, :i7U, 
417. 

sodio-benzoate, 382. 
Caffeina citrate, 38;5. 

effervescens, 383. 

sodio-salicylate, .382. 
Calamus, 148. 
Calcii hypophosphis, 119. 

bromidum, 328. 
f'akium lactoplinspliato, 120. 

o.\id, 30. 
Calendula officinalis, 204. 
Calomel, 72, 75, 1!£U, 134, 384, 

40G, 419, 443. 
(Calorific value of foods, 173. 
Calumba, 145, 1.51. 
Cal.v, .30. 

chlorinata, 39. 
Cambogia, 406. 

Camphor, 216, 320, 350, 3.58, 
390. 

liniment, 357. 

monobromated, 326. 

water. 65, 196. 
Camphorated soap liniment, 20.'). 
Campho-plienique, 65. 
Cancer cures, 226. 
Cancerous growths, 226. 
Cannabis indica, .303. 
Cantharidal cf)ll(idi(>n, 219. 
Canlharides, 341 K. 

cerate, 218. 
Canlharidin, 218. 
Capsicnin, 155, 2IIK. 

fantigiatum, 155. 

jihiHters, 212. 
Curamel, 469. 



Carbo ligni, 213. 

Carbolic acid, 28, 80, 250. 

acid as disinfectant, 40. 
Carmin, 468. 

Carminatiye, Dalby's, 158. 
Caniiinatives, 153. 
Carron oil, 231. 
Car3'ophyllus, 100. 
Cataplasma kaolini, 213. 
Cathartics, 393, 394. 

anhydrid group of, 403. 

saline, 410. 
Caseara sagrada, 102, .399, 4I12. 
Cassia fistula, 409. 
Castor fiber, 358. 

oil, 407. 
Castoria, 398. 
Caustic soda, 225. 
Caustics, 179, 54144. 
Cephiclis ipecacuanha, 273. 
CenUuin cantharidis, 218. 

resinae, 207. 
Cerebral excitement, .381. 
Clialk mixture, 185. 
Chamberlain's colic, cholera 

and diarrhea remedy, 158. 
Chapped hands, 231. 
Charcoal, 210, 213. 
Charta sinapis, 209. 
Chenopodium antlielininticimi. 

442. 
Chimaphila, 386. 

umbellata, 386. 
Cliirata, 146. 
Cliloral, 323. 

camphorated, 209, 212. 

hydrate, 323. 
Cliloralamid, 321, 324. 
Chloral formaniid, 321. 
Chloralose, 324. 
Chloralum hydratum, 323. 
Chloretone, 324. 
Chlorid of lime, 39. 

of zinc, 43. 
Chlorin, 39, 62. 

Chloroform, 51, 159, 205, 200. 
2.52, 256, 258, 2«0, 207, 451. 

and etlier, action of, 26i;. 

liniment, 200. 
Chlorosis, 100, 113. 
Cholera vibrio, 73. 
Cholin, 114. 

Chromii trioxidimi, 228. 
Chrysophanic acid, 395. 
Ciniicifuga, 148. 
Cinchona, 83, 149, 152. 
Cinnamic acids, 28, 58. 
Cinnamon water, 400. 
Circulatory depressants, 30.5. 
Cilrated cafTein. .383. 



PHARMACOPEIA AND PHYSICIAN. 



Citrate, iron ami ammonuim, 
96. 

of magnesia, 415. 
Citric acid, 383. 
Citrullus colocyntliis, 404. 
CitriKS vulgaris, 148. 
Claviceps, 363. 

purpurea, 363. 
Clay poultice, 213. 
Cleansing of hands, 48. 
Clemen's solution, 112. 
(,'linical thermomelevs, disinfec- 
tion of, 43. 
Cloves, 160. 
Coca, 283. 
Cocain, 45, 234, 2.38, 242. 

habit, 237. 

hydrochlorid, 38S. 

official preparations of, 238. 
C!ochineal, 468. 
Cocoa butter, 230. 
Cod liver oil, 122. 

liver oil emulsion, 123. 
Codein, 287, 288, 29G, 301, 302. 

phosphate, 287, 302. 

sulphate, 287, 302. 
Codii citras, 387. 
Coffee, 183, 381. 
Cold bathing, 202. 
Cold cream, 231. 

water, laxative action of. 424. 
Colds, 237, 269, 359, 389. 
Collapse, 334. 

Collodium cantharidatuni, 219. 
Coloeynthis, 404. 
Colon bacillus, 70, 71. 
Colophony, 207. 
Coloring, suggestive, 467. 
Compound digestive elixir, 1C8. 

kino powder, 185. 

liquorice powder, 290. 

mixture of glycyrrhiza, 290. 

powder of glycyrrhiza, 200. 

powder of morphin, 390. 

solution of creosol, 41. 

solution of iodin, 215. 

syrup of hypophosphites, 119. 

syrup of sarsaparilla, 466. 

syrup of squill, 278, 2.S3. 

syrup of white pine 276. 

tincture of cardamom, 464. 

tincture of lavender, 464. 
Confectio sennae, 398. 
Constipation, 401, 402, 424. 
Convallarise, 342. 
Convolvulus scammonia, 405. 
Copaiba, 455. 
Copper, 42. 

salts, 192. 

sulphate, 38, 42, 65, 192, 
225. 



Copperas, 38, 42. 
Corns, 225. 

smut, ustilago, 431. 
Corrosive mercuric clilorid, 37, 
49, 59, 129, 436. 

sublimate, 37. 
Cotton seed oil, 230. 
Coughs, 269. 
Counter-irritants, 201. 
Crede's soluble silver, 197. 
Creolin, 41. 

Creosote, 47, 81, 83, 2S3, 285. 
Cresol, 41, 42, 56. 

compound solution of, 56. 

detergent action of, 56. 
Cresolin, 41. 

Crile's pneumatic suit, .335. 
Croton chloral hydrate, 324, 

oil, 223, 224, 408. 

tiglium, 224, 408. 
Crotonoleic acid, 407. 
Cubeb, 455. 
Cucurbita pepo, 448. 
Cudbear, 468. 
Cumarin, 52. 

Cupri sulphas, 38, 192, 225. 
Cusso, 448. 
Cystogen, 384. 
Dalby's carminative, 158. 
Datura stramonium, 245. 
Delirium cordis, 338. 
Demulcents, 229. 
Depressants, circulatory, 365. 
Dermatol, 190. 
Dermatology, 57. 
Desiccated suprarenal glands, 

199. 
Deshler's salve, 208. 
Diabetes, 114. 
Diaphoresis, 388, 389. 
Diaphoretics, 388, 389. 
Hi'-rrhea, 72, 131, 186, 187, 

190, 408, 424. 
Diet, 162. 

Dietliylsulphone - dimethyl - meth- 
ane, 324. 
Dietaries, standard, 178. 
Digestants and dietetics, 162. 
Digestive elixir compound, 168. 
Diluted hydrobromic acid, 328. 
Digalen, 345. 

Digitalin, 338, 340, 341, 345, 
346. 

German, 341. 
Digitalinum verum, 338, 340. 
Digitalis, 339, 341, 347, S78. 

group, therapeutic action of, 
337, 342. 

purpurea, 339. 

tincture of, 341. 
Digitin, 340. 



INDEX. 



475 



Digitonin, 341, 344. 
Digitoxin, 33S, 340, 340. 
Dionin, 303. 

Dio.xymethyl antliiaquinone, 305. 
Diphtheria, 51. 

nisinfectants and antiseptics, 
local, 47. 
cliemical, 32. 
general, 2S. 
Disinfection, 28. 
moisture needed in, 34. 
of bedrooms, 35. 
of iKjdy, 48. 
of cesspools, drains, urinals, 

cellars, etc., 37. 
of clothing and instruments, 

48. 
of corpses, 37. 
of hands, 48. 

of wounds and ulcers, 40. 
sheet method of, 35. 
Disulphon - methyletlivl - meth- 
ane, 324. 
Di thymol di-iodid, 54. 
Diuresis, 377, 370. 
Diuretics, 377, 382. 
Diuretin, 383. 
Donovan's solution, 112. 
Dorniiol, 324. 
Dover's powder, 274, 301, 300. 

rwwder, liquid, 301. 
Dropsy, 403. 
Dryopteris feli.\-mas, 447. 

marginalis, 447. 
Dyspepsia, 114. 

fermentative, 77. 
Ecballium elaterium, 400. 
Elaterin, 400. 
Elm, slippery, 213. 
Eli.\ir adjuvans, 402. 
animonii valerianatis, 435. 
aromaticum, 402. 
cinchona;, pepsin et strycli- 

ninae, 168. 
cinchona;, ferri et pepsin, l(i8. 
ferri quinina; ot stryt-hnin.p 

phosphatum, 08. 
digesti\'um, 108. 
glycerophosphatuiii, 120. 
of terpin hydrate ami cr.deln 

sulphate, 285. 
of opium, 200. 
of paregoric, 200. 
pepsin et ferri, 108. 
pepsin, bismuthi et s(rv<h- 

nina;, 168. 
pepflin et bismuthi, 108. 
Eniodin, 304. 
Emollients, 201, li^O. 
Emplastrnm belladonna', 245. 
eapsiei, 200. 



Emulsion of castor oil, 400. 

of cod liver oil, 123. 
Emulsion asafoetids, 158. 
chloroformi, 150. 
olei morrhuae, 123. 
Epinephrin, 109, 236. 
Epispastics, 217. 
Epsom salts, 414. 
ICrgot, 262, 263, 430. 

testing of, 428. 
ICthacol, 286. 
ICssentia pepsini, 109. 
Ether, 159, 253, 255, 200, 207, 
301, 451. 
administration of, 204. 
compound spirit of, 100. 
Ethereal oil, 160. 
Ethyl alcohol, 203. 
bromid, 254. 
carbamate, 321, 325. 
chlorid, 256, 258, ::«0. 
morphin, 293. 
o.\id, 361. 
Eucain, 45, 237. 
Eugenia aromatica, 160. 
Euonymus, 406. 

atropurpureus, 406. 
Europhen, 53. 
Exalgin, 312. 
Exanthemata, 52. 
Exogonium purga, 403. 
Expectorants, 269. 
demulcent, 289. 
sedative, 271. 
stimulating, 279. 
Extract of belladonna leaves, 
244. 
of colocynth, compound, 404. 
of ergot, 430. 
of hematoxylon, 185. 
of hyoscyamus, 292, .■)n4. 
of Indian cannabis, 'MU. 
of malt, 168. 
of stramonium, 245. 
of witchhazel, 204. 
Extractum aloes, 397. 
cannabis indica;, 304. 
digitalis, 341. 
gentiana;, 145. 
glycyrrhizae purum, 289. 
leptandrJB, 405. 
malti, 108, 407. 
opii, 298. 
quassia;, 140, 442. 
rhamni purshiana;, 400. 
sumbul, 433. 
Eye, antisepsis of, 05. 
Feeding, infants, ]7.'i. 
Kol bovis, 442. 
Kollow's syrup, 117. 
l'"ennol water, 400. 



PHARMACOPEIA AND PHYSICIAN. 



Ferratin, 91, 93. 
Ferri carbonas saecharatus, 95. 
et ammonii tartras, 97. 

et pot;"is=ii t;irtr:is, 97. 

et .iuillili:r rillas. 97. 

et i|iiiniii:i' (■itr:is solubilis, 97. 
et stiy. lmiii:r citros, 97. 
hvdi-oxidum, 9!). 
snlphas, 38, 94. 
Ferric chlorirl, 192. 

chlnri.l. tiiK-tniv of. 94, lOH. 

eitiMt... !m;, lir„>, 1114. 111-,. 
hyl,n|.|,. .|,!,,lr. MM. 
Ferrous , ail.oiLitc 'x>, ](i:,. 
sulpliate, 38, 104. 
sulphate, dried, 94, 103. 
Ferrum reductum, 9(). 
Ferula, 157. 
Fever, malarial, 85. 
Fig, 410. 

syrups, 398. 
Filicic acid, 447. 
Flaxseed, 213. 
Flies, 30. 

Fluidextract of blackberry root 
bark, 185. 

ot geranium, 185. 

of licorice root, 289. 

of red rose, 185. 

of rluis glabra, 185. 
Fluidextractum aconiti, 24S, 
367. 

apocyni, 342. 

aurantii amari, 148. 

belladonna radicis, 245. 

berberis, 147. 

calami, 148. 

calumbse, 146. 

cannabis indicas, 304. 

capsici. 155, 208. 

ehimapbilae, 386. 

chirata?, 146. 

cimicifugs, 149. 

cinehonae, 150. 

convallarise, 342. 

digitalis, 341. 

ergota", 430. 

gentianse, 145. 

liypophosphite, 119. 

glycyrrhizcB, 289. 

granati, 448. 

bydrastis, 149. 

ipecacuanhse, 274. 

leptandrJe, 405. 

nvicis vomicre, 1-50. 

pilocarpi, 392. 

podophvlli, 405. 

quassife, 146, 442. 

rhamni purshianae, 400. 

sanguinariae, 275. 

scilbr-. 281. 



Fluidextractum scopola^, 308. 

senegse, 275. 

senna;, 398. 

seriJentariae, 149. 

spigeliae, 441. 

staphisagriae, 438. 

stramonii, 245. 

sunibul, 432. 

uvK iirsi, 386. 

viburni opuli, 433. 

Valerianae, 434. 

veratri, 370. 

virburni prunifolii, 434. 

zingiberis, 154. 
Food preservatives, 45. 

amount of iron in, 101. 
Foods, calorific value of, 173. 

predigested, 175. 
Foot baths, mustard, 210. 
Formaldehyd, 33, 45, 65, 385. 

solution, 44. 
Forniio, acid, 214. 

aldehyd, 33. 
Fowler's solution. 111. 
Fracture of bones, 120. 
Fraenkel solution, 2.58. 
Frangula, 395. 
Fraxinus ornus, 410. 
Friar's balsam, 281. 
Cadtis iii..irluue, 123. 
(;;illir afid, 1S7. 
(Jniiibir, ISl, 1S4. 
Gamboge, 406. 
Garcinia hanburii, 406. 
Gargles, 62. 
Gastric juice, 73. 

ulcer, 188. 
Gastritis, chronic, 197. 
Gentiana, 144. 
Gentian bitters, 151. 

and orange bitters, 151. 
Geranium, 185. 
Ginger, 154. 
Glandulae suprarenales siccae, 

199. 
Glanduls thjToidae siccae, 142. 
Glonoin, 374. 
Glucose, 324. 
Glycerin, 40, .59, 229, 232, 423. 

magmas, 214. 
Glycerite of boroglycerin, 64. 
of phenol, 2.51. 
of starch, .59. 
Glyceritum acid tannici, 184. 
amyli, 59. 
boroglycerini, 64. 
ferri quininae et strychninae 

phosphatum, 98. 
pepsini, 168. 
phenolis, 251. 
Glycerol, 229. 



INDEX. 



Glvcerophosphoric acid, 120. 
Glyceryl trinitrate, 372, 373. 
Glycj-rrhiza, 289. 

compound mixture of, 290. 

compound powder of, 39S, 424. 
Glycerrhizin, 459, 468. 
Glycyrrhizinum ammoniatuni, 

290. 
Goiter, hyiwplastic follicular, 

142. 
Golden yellow mLxture, 469. 
Gonorrhea, 451, 453, 456. 
Gossypii corte.x, U. S. P., 431. 
Goulard's extract, 191. 
Granatum, 447. 
Gray powder, 419, 127. 
Green soap, 437. 
Griffith's mixture, 95. 
Grindelia robusta, 222. 
Guaiacol, 81, 83, 286. 
Guarana, 381. 
Hagenia abyssinica, 448. 
Hands, disinfection of, 4S. 
Hay fever, 235. 

fever remedies, 236. 
Headache, 212, 319. 
Heart, dilatation of, 344. 

disease of, 262. 

fatty degeneration of, 344. 

tonic, 330. 
Heat, 31, 213, 335. 
Helmitol, 385. 
Hematin, 91. 
llematinics, 91. 
Hematogen, 92. 
Hematoxylon, 185. 
Hemoglobin, 91. 
Hemorrhage, 362. 
Hemorrhoids, 242, 24C. 
Hemp, Canadian, 348. 
Hernia, strangula^ted, .393. 
Heroin, 303. 

He.xametliylenaniin, 82, 385. 
History of Pharmacopeia, 11. 
Hive sjTup, 284. 
Hoffman's anodyne, 361, 160. 
Homatropin hydrochlorid, 307. 
Humanized milk, 170. 
Humanized milk powder, IGO. 
Hunyadi water, 415. 
Huxam's tincture, LW. 
Hydrargyri chloridum corrosi- 
vum, 37, 00, 129. 

chloridum mite, 129, 419. 

iodidum flavum, 128. 

iodidum nibnim, 59, 128. 
Hydrargyrum, 127. 

cum creta, 127, 419. 
Hydrastinin, 198. 
HydrastiB, 149. 

Hydrntod chloral. 321, '.i'2H, 
37«. 



Hydrazin, 311. 
Hydrobromic acid, 328. 
Hydrobromids, 328. 
H.vdrochinon, 385. 
Hydrochloric acid, 73, TO. 

acid, dilute, 76. 
Hydrocyanic acid, 243, 2S9, 153, 

165. 
Hydrogen dioxid, 44, 50, 62, 64, 

66, 76, 182. 
Hydroxybenzene, 55. 
Hydroxylamin, 311. 
H3-oscin, 308. 

Hyoscyaminae sulphas, 30e>. 
Hyoscyaminae hydrobromidum, 

308. 
HjT)naI, 312, 323. 
Hypodermic sjTinges, 43. 
Hypophosphites, 119, 121. 
Indian cannabis, 303. 
Indigestion, 154. 
Infant feeding, 173. 
Infectious diseases, spread of, 

48. 
Inflammation of stomach, 188. 
Infusion of dieitalis, 341. 

of uva ursi, 386. 
Infusum digitalis, 341. 

sonn.-E compositum, 399. 
Injections, intraspinous, for an- 
esthesia, 241. 
Insecticide, 58. 
Instrument disinfection, 48. 

sterilization, 41. 
Intestinal antiseptic, 73. 
Intestine, closure of, 393. 

spasmodic constriction of, 393. 
Introduction, 9. 
lodids, !»<;. 

soluble, 461. 
lodin, 44, 45, 79, 215, 210. 

compound solution of, 80, 138, 
21.5. 
Iodoform, S51, 52, 00. 

gauze, 53. 
lodol, 53. 
lodum, 79, 137. 
lodothyrin, 141. 
Ipecac, 272, 273, 277. 
Iron, 91, 90. 

acid albumin, 91. 

albuminate of. 91, 93. 

amount in food, 101. 

and ammonium citrate, 90. 

and quinin citrate, 97. 

and strychnin citrate, 97. 

chlorid of, 195. 

compound mixture of, "J5. 

inflications for, 100. 

inorganic, JH, 94, 104. 

organic, 92. 

peptonate of, 93. 



478 



PHARMACOPEIA AXD PHYtilCIAN. 



Iron, reduced, 10, 96. 

saccharated carbonate of, 95. 

scale salts of, 96, 104, 461. 
Irritants, 201. 
Iso-punicin, 448. 
Itch, 436. 
.Jaborandi, 391. 
Jalap, 403. 

powder compound, 404. 
Jamaica quassia, 146, 442. 
Jateorhiza palmata, 145. 
Junket, 171. 

Juniperus oxycedrus, 58. 
Kairin, 314. 
Kamala, 446. 
Kaolin, poultice of, 213. 
Kidneys, infection of, 82. 
Kino, 1S5, 186. 
Kola, 381. 

Kopp's Baby's Friend, 159. 
Koso, 448. 
Kosotoxin, 446. 
Krameria, 186. 
LabaiTaque's solution, 40. 
Lactophenin, 313. 
Lactucarium, 305. 
Lady Webster's dinner pill, 397. 
Lanolin, 229. 
Larkspur, 438. 
Laudanum, 299. 
Lausekorner, 438. 
Laxatives, 409. 
Lead acetate, 191. 

salts, official, 191, 194. 

subacetate, solution of, 191. 
Lecithin, 116. 
Leptandra, 405. 
Leucin, 70. 
Licorice, 289. 

root, 289. 
Lime, 36. 

chlorinated, 39. 

liniment, 231. 

milk, 36. 
Linimentum belladonna, 245. 

calcis, 231. 

camphorae, 357. 

chloroformi, 205, 206. 

saponis, 205. 

terebinthinae, 208. 
Linseed, 213. 
Linum, 213. 
Liquid carbolic acid, 55. 

petrolatum, 230. 

rennet, 170. 
Liquified phenol, 55, 251. 
Liquor acidi arsenosi. 111. 

ammonii acetatis, 390. 

antisepticus, 44, Gl, 63. 

arseni et hydrargvri iodidi, 
112. 



Liquor auri et arseni bromidi, 
112. 

cresolis compositus, 41, 56, 65. 

cresoli saponatus, 41. 

ferri chloridi, 192. 

ferri et ammonii acetatis, 99. 

formaldehydi, 34. 

hydrargyrl nltratls, 227. 

iodi compositus, SO, 215. 

magnesii citratis, 415. 

pancreaticus, 168. 

pepsini, 168. 

plumbi subacetatis, 191. 

pepsini aromatlcus, 168. 

potassi areenitis, 34, 111, 112. 

potassii citratis, 390. 

seriparus, 170. 

sod» chlorinatae, 40. 

sodii arsenatis, II',;. 

sodii phosphatis compositus, 
417. 

zinci et alumini compositus, 
40. 

zinci et ferri compositus, 40. 
Lithii bromidum, 328. 
Lithii carbonas, 3558. 

citras effervescens, 38S. 

salicylas, 388. 
Lithium salicylate, 388. 
Loganiaceae, 350. 
Loretin, 53, 54. 
Losophan, 53, 54. 
Louse, 438. 

Lugol's solution, SO, 215. 
Lumbago, 246. 
Lunar caustic, 196, 226. 
Lymphosarcoma, 114. 
Lysitol, 41. 
Lysol, 41. 

McMunn's elixir of onium, 300. 
Magnesii carbcrnas, 415. 

oxidum, 415. 
Magnesium sulphate, li50, 414. 

sulphate, effervescent, 415. 
Malaria, 85. 
Male fern, 445, 447. 
Mandrake root, 405. 
Manganese, 105, 106. 

dioxid precipitated, 100. 

hypophosphite, 119. 

preparations, peptonized, 105. 
Mangani dioxidum precipitatnm, 
106. 

hypophosphis, 119. 

sulphas, 107. 
Manna, 410, 399. 
Massa ferri, carbonatis, 95. 

hydrargjTi, 128, 419. 
Matico, 384. 
May apples, 405. 
Medicated waters, 459. 



nDEX. 



Menstruation, 317. 
Mentha piperita, 15«, 209. 

viridis, 156. 
Menthol, 209, 212. 
Mercurial ointment, 60. 
Mercurials, 59, 126, 127, 130, 

413. 
Mercuric chlorid, 37, 42,' 49, 59, 
60, 65, 227. 

iodid, 128. 

nitrate, 227. 

o.xid, red, 60, 436. 

salicylate, 134. 
Mercurous chlorid, mild, 75, 
, 129, 134, 419. 

iodid, 128, 132. 

iodid, yellow, 128. 
Mercury, 127. 

h.vpodermic injection of, 134. 

in preeTiancy, 132. 

with chalk, '127, 419. 
Methemoglobin, 310, 371. 
Methyl acetanilid, 312. 

alcohol, 203. 

punicin, 448. 

salicylate, 88, 216. 
Mierraine, 387. 
Milk, humanized, 170. 

peptonized, 171, 172. 

powder, 169. 
Mineral acids, 41. 
Mints, official, 15G. 
Mistura ammonii ehloridi, 290. 
Mistura cretse, 185. 

carminativa, 158. 

chloroformi et cannabis in- 
dica composita, 158. 

chloralis ct potassii bromidi 
composita, 292. 

sodiB et mentliK, 157. 
Mitral stenosis, 343. 
Mixture for general anesthesia, 

2.55. 
>fonobromated camphor, 32C. 
Morphin, 280, 301, 323, 337, 350, 

352. 
Aforphinfp acetas, .301. 

hydrnchloriduni, 301. 

sulphas, 302. 
Moschus moschifortis, 358. 
Mouth wash. 51. 
M. S. mixture, 2.55. 
Nfucilago acacia?, 289, 407. 

tragacantha;, 220, 407. 
Mucous membrane, antisepsis of, 
01. 

membranes, local treatment 
of. 195. 
Muriatic arid. 70. 
Musearin. 3.')5. 
MuHk. 358. 



Mustard, 161, a09, 21S. 

paper, 209. 

poultice, 210. 
Mydriatics, 307. 
Myocardium, improved nutrition 

of the, 333. 
MjTcedema, 141. 
Naphthalen, 49, 73, 77, 451. 
Naphthol, 49, 77. 
Nasal passage, antisepsis of, 63. 
National Formulary, 14. 
Nephritis, 218, 37S", 384. 
Nerves in teeth, destruction of, 

227. 
Neuralgia, 212, 246, 249. 
Niemeyer's pills, 378. 
Nitric acid, 227. 
Nitrites, 370, 373, 374. 
Nitroglycerin, 372. 
Nitrous oxid, 252. 
Norwood's tincture of veratrum, 

Nosophen, 53. 

Nuclein, 116. 

Nutmeg, 161. 

Nux vomica, 150, 350. 

Obesity, 125, 141. 

Oil of almonds, expressed, 230. 

of American worm seed, 444. 

of cade, 57. 

camphorated, 357. 

castor, 408. 

of chenopodiuin, 444. 

of cinnamon, 161. 

of cloves. 161, 206. 

of copaiba, 206, 455. 

cotton seed, aSO, 408. 

croton, 408. 

of cubeb, 450. 

ethereal, 160. 

of juniper, 384. 

of juniper .tar, .57. 

of mustard, volatile, 209. 

olive, 230, 408. 

of pennyroyal, 206. 

petroleum, 124. 

purgative, 407. 

of sandalwood, 206, 455. 

of santal, 455. 

of savin, 207. 

of theobroma, 2.'?0. 

of thymus vulgaris. .50. 

of turpentine, a07, 211, .384. 

of turpentine, rectified, 451. 

volatile, 61, 147, 206, 384. 

of wintergreon, 88, 80. 
Ointment of anmioniatod mer- 
cury, 228. 

rarlxilie, 439. 

of bellad.mna. 244. 

of nierciirif nitrate, 227. 



PHARMACOPEIA AXD PHU^ICIAX. 



Ointment of niorcuiy, GO. 

of phenol, 251. 

of red mercuric oxid, 60. 

of red precipitate, 60. 

of rose water, 231. 

stramonium, 216. 

of sulphur, 58. 

of tar, 57. 
Oleate of atropin, 211. 

of cocain, 23y. 

of veratrin, 249. 
Oleoresin of aspidiuni, -447, 

450. 
Oreoresina aspidii, 447. 

eapsici, 155, 208, 212. 

cubebae, 456. 

zineiberis, 154. 
Oleum amygaalSB cxpressum, 

230. 
Oleum betulae, SS. 

cadinum, 58. 

caryophylli, 161. 

chenopii, 442, 444. 

copaibae, 455. 

cubebae, 456. 

gaultheris, 88. 

gossypii seminis, 230. 

jecoris aselli, 123. 

menthae piperitae, l.")6. 

morrhuae, 123. 

oliva5, 230. 

ricini, 408. 

rosmarini, 207. 

sabinae, 207. 

santali, 455. 

sinapis volatile, 20i». 

terebinthinae, 207. 

theobromatis, 230. 

tiglii, 224, 408. 

vitroli dulce, 361. 
Opii puivis, 298. 
Opium, 187, 293, 1!5>S. 

deodoratum, 298. 

deodorized tincture of, 209. 

McMunn's elixir of, 299. 

official preparations of, 298. 

poisoning, 355. 
Orange and gentian bitters, 151. 
Osteomalacia, 120. 
Ourouparia gambir, 18*. 
Ovis aries, 229. 
Oxyanthraquinone, 394. 
Oxyuris vermicularis, 44. 
Packer's tar soap, 221. 
Pancreatin, 164, 167. 
Pancreatinum, 167. 
Papayotin, 166. 
Para- amido- phenol, 313. 
Paraldehyd, 321, Sa4. 
Paralysis, local intestinal. 393. 
Parasitic fungi, 59. 
Parasiticides, 61, 436. 



Paregoric, 299. 

Parenchyniatous n e p h r i t i s, 

chronic, 420. 
Patent medicines for coughs, 

269. 
Peacock's bromids, 327. 
Pearls ^f amyl nitrite, 375. 
Pearson's solution, 112. 
Pediculi, 60. 
Pediculus pubis, 438. 
Pelletierin, 446, 450. 

tannate, 448, 450. 
Penicillium brevicaule, 107. 
Pepo, 448. 

Pepper, 161. V 

Peppermint, 150. 

water, 460. 
Pepsin, 163, 164, 167. 
Pepsinum saccharatuni, 168. 
Pepsinum, 167. 
Peptomangan-Gude, 105. • 
Peptonate of iron, 93. 
Peptonized milk, 171. 
Peptonized manganese prepara- 
tions, 105. 
Peptonizing powder, 169. 
Periostitis, 139. 
Peristalsis, 72, 76, 396. 
Peritonitis, 154, 393. 
Peru balsam, 53. 
Petrolatum, 230. 

saponatum, 215. 

album, 230. 

liquidum, 230. 
Petroleum ether, 254. 

oils, 124. 
Pharmacopeia, 9. 
Phenacetin, 309, 310, aio, 319 

320. 
Phenalgin, 314. 
Phenetidin, 313. 
Phenocoll, 313. 

Phenol, 28, 40, 44, 47, 54, 55 
63, 235, aoO, 251, 311, 444. 

sodique, 80. 
Phenolphthalein, 422. 
Phenolsulphonie acid, 81. 
Phenylaeetamid, 3ia, 315. 
Phenyl-dimethyl-pyrazolon, 316. 
Phenylhydrazin, 311. 
Phenyl salicylate, Sa, 87, 88. 
Phosgene, 256. 
Phosphates, 117. 

of iron, quinin and strychnin, 
98. 
Phosphoric acid, 118. 
Phosphorus, 114, 118, 119, 121. 

and its salts, therapeutics of, 
120., 
Plithisis, 117. 

Picrasnia excelsa, 146, 442. 
Picrol, 54. 



IXDEX. 



481 



I'ills of aloes and iron, 94, 102, 
397. 

of asafetida, 157. 

of aloes and mastic, 397. 

of aloes and myrrh, 397. 

Blaud's, 94, 103. 

compound cathartic, 404. 

of ferrous carbonate and po- 
tassium sulphate, 94, 103. 

Francis', 407. 

Griffith's, 94, 103. 

Lady M'ebster's dinner, 397. 

of lead and opium, 188. 

of phosphorus, 118. 

of rhubarb, compound, 397. 

triplex. 407. 

vegetable cathartic, 397, 404. 
Pilocarpin, 390, 391. 

nitrate, 390, 392. 
Pilocarpus, 391. 
Pilula aloes, 397. 
PiluliB aloes et ferri, 94. 

asafetidip, 157. 

cathartieae compositae, 397. 

ferri carbonatis, 94. 

laxativ.-e composite, 397. 

opii, 298. 

phosphori, 118. 
Pink root, 441, 444. 
Pinus, 57, 207. 

paUistris, 207. 
Pipsissewa, 386. 
Pi.\ liquida, 57. 
Plasters, resin, 208. 

rubefacient, 208. 
Plumbi acetas, 191, 456. 
Podophyllum, 405, 407. 
I'oison oak, 221. 
Polypala senepa, 275. 
Pomepianate, 447. 
Pomegranate root bark, 449. 
Potassa, 225. 
Potassii chloras, G2. 

acetas, 387. 

bitartras, 387. 

ct sodii tartras, 416. 

ritras, 387. 

bromidiim, 328. 

hypophosphis, 119. 

iodidum, 139. 

nitras, 387. 

permanganas. 66, 107, 454. 
Potassium and antimony tar- 
trate, 1423, 276. 

bicarbonate, l.')7. 

bitnrtrate, 404. 

hromid. 292. 328, 381. 

chlonitp, 02. 

citrate. HH7, 460. 

hydroxid, 225. 

livpopliospliitp, no. 

iodid, 125, 132, 139, 327. 



Potassium peiniahganate, 41, 66, 
107. 

sulphate, 193. 
Poultices, 213. 
Powder, antiseptic, astringent, 65. 

compound of glycjTrhiza, 398, 
424. 

Dover's, 274, 301, 390. 

of ipecac, 274. 

of ipecac and opium, 274, 390. 

of opium, 274. 
Powdered blue mass, 12S. 
Precipitate, red, 438. 
Predigested foods, 175. 
Pregnancy, use of mercurials 

in, 420. 
Presen'atives, 46. 
Probilin, 422. 
Proteid requirements, 177. 
Protozoon, 85. 
Prune, 410. 
Pseudo-punicin, 448. 
Pterocarpus niarsupiuni, 1S5. 
Ptyalin, 164. 

Pulvis acetanilidi compositus, 
315. 

antisepticus, 65. 

glycyrrizae compositus, 290, 
398. 

iodoformi compositus, 52. 

ipecacuanha; et opii, 274, 301, 
390. 

jalapae compositus. 404. 

morphinae compositus, 390. 

pancrcaticus compositus, 109. 

pepsin compositus, 108. 

pro lacte hiuuanisato, Ui!). 
Pumpkin seed, 447. 
Punica granatum, 447. 
Punicin, 448. 
Purgatives, 393. 
Pustulants, 222. 
Pyrogallic acid, 57. 
Pyrogallol, 57. 
Quassia, 146, 442. 
Quinin, 68, 83, 311. 
Quinin.-B bisulphas, 84. 

Iiydiobromidum, 84. 

Iiydrochloriduni, 84. 
Quininrc salicjdas. 84. 

sulphas, 84. 
Quinolin, 53, 311. 
lied coloring, 4(i8. 

iodid, 128. 

mercuric iodid, 59, 128. 

wine, 465. 
Rc<luced iron, 90. 102. 
Hcnnet, liquiil, 17ll. 
Hennin, ](i(i. 
Hcsin of .Talnp, inf. tOtl. 

of scammoiiv, 4(i5. 

plasfcrs, 208. 



482 



PHARMACOPEIA AND PHYSICIAN. 



Resina, 207. 

podophylli, 405. 
Resorein, 57. 
Rhamnus purshiana, 399. 
Rheum, 57, 399. 
Rheumagon, 418. 
Rheumatism, 249. 

chronic, 136. 
Rhubarb, 389, 399, 402. 

official preparations of, 399. 
Rhus glabra, 185. 

poisoning, 221. 
Ricinus communis, 408. 
Rickets, 120, 124. 
Rochelle salts, 416. 
Rose, red, 185. 
Rose water, 231. 
Rosin, 207. 

Rosmarinus officinalis, 207. 
Rubefacient plasters, 207. 
Rubefacients, 202. 
Rubus, 185. 
Runiex, 3yo. 
Sacred bark, 403. 
Salacetin, 314. 
Sal alembroth, 60. 

ammoniac, 283. 
Salicin, 88. 

Salicylates in rheumatism, 87. 
Salicylic acid, 45, 57, 58, 86, 

311. 
Saline cathartics, 410. 

diuretics, 386. 

purgatives, 412, 414. 
SalipjTin, 312. 
Salol, 82, 87, 88, 401. 
Salophen, 313. 
Salt, common, 64. 

solution, physiologic, .335. 
Salts, purgative, 412. 

of lithium, 387. 

Rochelle, 416. 
Sanguinaria, 275. 
Sanguinarin, 275. 
Santalol, 455. 
Santalum album, 4.55. 
Santonin, 441, 443. 
Sapo mollis, 437. 
Saponated petrolatum, 216. 
Sarcoptes scabies, 436. 
Sarsaparilla, compound s^rup of, 

466. 
Scabies, 436. 
Scalds, 66. 

Scammony, 405, 406. 
Schleich's infiltration method, 
241. 

mixture, 255. 
Scilla, 281, 241. 
Scoparin, 383, 379. 
Scoparius, 383. 



Scopola, 307. 

carniolica, 307. 
Scopolamin-morphin solution, 

257. 
Scopolamina; hydrobromidum, 

308. 
Scotch oats, 300. 
Semen staphidis pedicularis, 438. 
Senega, 275. 
Senna, 397, 398, 401. 
Serpentaria, 149, 152. 
Serum, Beebe's, 125. 
Shock, 247, 255, 334, 351, 361, 

362. 
Silver, 193. 

iodid, 454. 

nitrate, 65, 193, 225, 454. 

nitrate, internal use or, 197. 

nitrate, mitigated, 225. 

nitrate, use of, 196. 

proteid combination of, 197. 

soluble, 197. 
Sinapis alba, 209. 

nigra, 209. 
Slippery elm, 213. 
Smelling salts, 360. 
Soap liniment, 205. 

liniment, camphorated, 205. 

Packer's tar, 221. 
Soda, 32. 

mint tablets, 157. 
Sodii arsenas, 110. 

acetas, 387. 

arsenas exsiccatus, 110. 

hypophosphis, 119. 

nitris, 373. 

sulphis, 437. 
Sodium acetate, 383. 

benzoate, 382, 460. 

bicarbonate, 62, 157, 222. 

borate, 64, 65. 

bromid, 320. 

chlorid, 64, 336. 

liypophosphite, 119. 

hyposulphite, 59. 

iodid, 418. 

nitrite, 373. 

phenosulphate, 64, 81. 

phosphate, 416. 

salicylate, 87, 381, 382, 460. 

santoninate, 440. 

sulphocarbolate, 64, 81. 

thiosulphate, 59, 215. 
Solution, alkaline antiseptic, 62. 

of arsenous acid, 111. 

of chlorinated soda, 40. 

Donovan's, 112. 

of ferric chlorid, 94. 

of formaldehyd, 34. 

Fowler's, 111. 

Fraenkel's, 258. 

of hydrogen dioxid, 50. 



INDEX. 



483 



Solution of iodin, compound, SO. 

of iron and ammonium ace- 
tate, 99. 

Lugol's, SO. 

Pearson's, 112. 

of potassium arsenite. 111. 

of potassium citrate, 3!>0. 

of sodiimi arsenate, 112. 
Soporifics, 291. 
Sore throat, 51. 
Sozoiodol, 54. 
Spanish flies, 21S. 
Spartein, 383. 
Sparteine sulphas, 3S3. 
Spearmint, 150. 

spirit of, 463. 

water, 460. 
Spigelia, 441, 444. 

marilandica, 441. 
Spirit of ammonia, 359. 

of anise, 462. 

of bitter almonds, 402. 

of cinnamon, 403. 

distilled, 300. 

of ether, 361. 

of gaultheria, 403. 

of glyceryl trinitrate, 372. 

f>f mindererus, 390. 

of niter, sweet, 390. 

of nitroglycerin, 372. 

of nitrous ether, 372. 

of peppermint, 156, 403. 

of spearmint, 403. 
Spiritus aethcris, 160, 361. 

anisi, 462. 

xtheris compositus, 100, 301. 

.xtlieris nitrosi, 390. 

ammoniae aromatlcus, 359. 

amygdalae amara;, 462. 

camphorsE, 205, 357. 

cinnamomi, 403. 

chloroformi, 159. 

frumenti, 205, 300. 

gaultheria*, 463. 

glonoini, 372. 

glycerylis nitratis, 372. 

inenthaB piperita;, 150, 403. 

menthac viridis, 463. 

vini gallici, 205, 301. 
Splanchnic area, 353. 
Stavesacro, 438. 
Squill, aSl, 379, 384. 
Staphisagria, 438. 
Steam, moist, 32. 
Sterilization of hypodermic so- 
lutions, 44. 

of surgical Instruments, 48. 
Stimulant, cardiac, 330, 379. 

circulatory, »»0, 331. 

rcupiratory, .352. 
Stimulation, mechanism of, 331. 

of constrictor mechanism, 335. 



Stomachics, 143. 
Stovain, 45, 231. 
Stramonium ointment, 245. 
Strontii bromidum, 328. 

iodidum, 139. 

salicylas, 88. 
Strontium salts, 327. 
Strophanthin, 341, 346, 347, 348. 
Strophanthinum, 341. 
Strophanthus, 338, 341, 379. 

kombe, 341. 

seed, 347. 
Strychnin, 90, 349, 350, S52. 

vasoconstrictor, effect of, 375. 

nitrate, 351. 

sulphate, 351. 
Strychnina nux vomica, 350. 
Styptics, 199. 
Sugar, 46. 

of lead, 191. 

of milk, 383. 
Sulphonal, 324, 321. 
Sulphonethylmethane, 321, 324. 
Sulphonmethane, 321, 324. 
Sulphur lotum, 58, 420. 

ointment, 58, 437. 

precipitatum, 5S, 420. 

siiblimatum, 38, 58, 420. 

w.ashed, 58. 
Sulphuric ether, 159, 361. 
Sulphurous oxid, 38. 
Sumbul root. 358, 432. 
Sunburn, 231. 
Sunlight and heat, 31. 
Supersaturated air, 32. 
Suprarenal alkaloid, 236. 
Suppositories, 423. 
Suprarenal gland desiccated, 198, 

lOi), 236. 
Suprarenin, 199, 236. 
Surgical dressings, 51. 
Sweet flag, 148. 

orange peel, tincture of, 463. 
Swortia chirayita, 146. 
Syphilis, 130. 

tertiary, 139. 
Syrup of blackberry root bark, 
185. 

of citric acid, 405. 

Fellows', 117. 

of hydriodic acid, 138. 

of hypophosphites, compound, 
119. 

of iodid of iron, 138. 

of ipecac, 274. 

of orange, 465. 

of red rose, 185. 

of sennn, 398. 

of squill, 2S1. 

of squill, coniixiund, 270, -S-. 

of tar, 2.S2. 288. 



PHARMACOPEIA AXD PHYSICIAX. 



Synip of tohi, 2S0. 

of white pine, 276. 

of wild cherry, 287, 466. 
S.vrupus, 459. 

acaciae, 289_, 467. 

acidi citrici, 465. 

calcii lactophosphatis, 120. 

ferri iodidi, 138. 

ferri, quininse et strychinns 
phosphatum, 98. 

lactucarii, 305. 

picis liquidse, 282. 

pruni virginianse, 287, 466. 

aurantii, 465. 

sarsparillse compositus, 466. 

senegae, 275. 

tolutanus, 466. 
Tablets, soda mint, 157. 
Taenia inermis, 446. 

saginata, 445. 

serrata, 446. 

solium, 445. 
Talcum, 57, 401. 
Tamar-Indien, 399. 
Tamarindus, 410. 
Tannate of pelletierin, 450. 
Tannic acid, 180, 182, 1S4. 
Tannin, 180, 182, 451. 
Tapeworm, 184, 445. 
Tar, 47, 57. 

ointment, 57. 

soap, 436. 
Tartar emetic, 223, 276, 
Tea, 183, 381. 
Teeth, carious, 327. 
Teniafuges, 445. 

official substances used as, 447. 
Tenicides, 445. 
Terebene, 283. 
Terebine, 285. 
Terebinthina, 207. 
Terpin hydrate, 282, 2S4, 285. 
Tetra-iodop5Trol, 53. 
Thallin, 314. 
Thea sinesis, SSI. 
Thebaica, 297. 
Theobromin, 381. 

sodium, 382. 
Thermometers, clinical, disin- 
fection of, 43. 
Thermo-cautery, 224. 
Thj-mol, 56, 81, 82, 444, 4oC. 
Thymol iodid, 53, 55. 
ThjTnus \'Tilgaris, oil of, 56. 
Thyroid gland, 125, 141. 

disease, 125. 
Tinctura aconiti, 248, 367. 

arnicas, 204. 

asafetid;e, 157. 

aurantii amari, 148. 



Tincture aurantii dulcis, 463 
benzoini composita, 281. 
calenduL-E, 204. 
calumbae, 146. 
cannabis indicae, 304. 
cantharidis, 219. 
capsici, 155, 208. 
cardamomi composita. 



464, 



cimicifugae, 149. 

cinchonse, 150. 

cinchonae composita, 150. 

digitalis, 341. 

ferri chloridi, 94, 192. 

gambir composita, 184, 188. 

gentianns composita, 145. 

hydrastis, 149. 

iodi, SO, 138, 215. 

ipecacuanhae et opii, 301. 

kino, 1S5, 187. 

lactucarii, 305. 

lavandulfe composita, 464. 

limonis corticis, 464. 

moschi, 358. 

nucis vomicK, 150, 461. 

opii, 299. 

opii camphorata, 299. 

opii deodorati, 299. 

quassias, 146, 442. 

scillae, 282. 

serpentariae, 149. 

strophanthi, 342. 

tolutana, 380. 

Valerianae, 434. 

vanills, 464. 

veratri, 370. 

viburni opuli composita, 433. 

zingiberis, 154. 
Tincture of aloes, 397, 401. 

of aloes and myrrh, 397. 

of calumba, 461. 

of cardamom, 464. 

of cudbear, 468. 

Huxam's, 150. 

of krameria, 187, ISS, 190. 

of larlvspur, 438. 

of soap, camphorated, 205. 

of stavesacre, 438. 

of sweet orange peel, 463. 

of thebaica, 297. 
Toluifera balsamum, 279. 
Tonics, general, 90. 
Toxicodendrol, 222. 
Toxicology of strychnin, 350. 
Tragacanth, mucilage of, 229, 

467. 
Tri-iodomethane, 51. 
Tricophyton tonsurans, 436. 
Trional, 321, 324, 325. 
Tri - oxv - methyl - anthroquinone, 
394. 



IXDEX. 



Trochisci acidi tannici, 1S4. 

animonii chloridi, 2S4. 

gambir, 185. 

glycyrrhizje et opii, 2Sa, 301. 
Trypanosomiasis, 114. 
Trypsin, ICC. 
Tubercle bacillus, 73. 
Tuberculosis, 117, 121, 124, 420. 
Turlington's balsam, 2S1. 
Turpentine, 207. 
TuUy's powder, 390. 
Typhoid bacilli, 32, 42, 75. 

fever, 79. 
Tyree's antiseptic powder, 55. 
TjTosin, 70. 

Ulcerations of throat, I'Jo. 
Ulcere, G6, ISS. 
Ulmus, 213. 

fulva, 213. 
Unguentum, 231. 
Ungucntum aqux rosa, 231. 

belladonnae, 244. 

hydrargjri, 60. 

hydrargjTi ammoniati, 22S. 

hydrargi'ri nitratis, 227. 

hydrargyri axidi rubri, CO. 

iodi, 215. 

phenolis, 251. 

picis liquids;, 57. 

stranionii, 24C. 

sulphuris, 58, 437. 

veratrinae, 248. 
United States Pharmacopeia, 7. 
Urea, 383. 

Urethane, 313, 321, 325. 
Urginea maritima, 281. 
Uric acid solvent, 387. 
Uriform, 385. 

Urine, discoloration from phe- 
nol, 55. 
Urotropin, 384. 
Uva ursi, 385. 
Vagina, antisepsis ofj Co. 
Vallet's mass, 95. 
Valeriana, 434. 
Valeriana officinalis, 434. 

pills, 95. 
Vasoconstriction, 198, 347, 379, 

380. 
Vasoconstrictors, 197. 
Vasomotor spasm, 374. 
Vogotable calomel, 407. 
infusions, 389. 



Vehicles, substances used as, 

457. 
Veratrin, 247, 24S, 370. 

ointment, 248. 
^'eraTrum, 309. 

viride, 309, 370. 
^'ermicides, 439. 
^'ermifuges, 349. 
I Vesication, iil7, 218. 
I Vesicants, 217. 
j ^'iburnum prunifolium, 433. 
opulus, 433. 
A'inegar of opium, 299. 
of squill, 281. 
Vinum album, 404. 
antimonii, 270. 
ergotar, 430. 
■ ferri, 98. 

ferri amarum, OS. 
i ipecacuanha;, 274. 
I opii, 299. 
I rubrum, 404. 
j A'ioform, 53. 

Virginia snakeroot, 149. 
A'itis vinifera, 465. 
A'olatile oils, 46, 56. 
Warts, 225, 228. 
Waters, medicated, 459. 
Whey, 171. 

Whisky, 205, 360, 361. 
White mustard, 209. 
Wine of ipecac, 274. 
of iron, bitter, 104. 
white, 464. 
of opium, 299. 
Winslow's Soothing Syrup, Mi's., 

158. 
Wintergreen, 463. 
Witchhazel extract, 204. 
Worm seed, American, 444. 
Wool fat, 229. 

Yellow mercurous iodid, 128. 
Zinc acetate, li)'^, 456. 
and arsenic chlorid, 226. 
chlorid, 65, :J::«. 450. 
oxid, 57, 192. 
phenolsulphonate, SI, 101, 

456. 
salts, use of, 196. 
sulphate, 191, 45(;. 
sulphocarbolatc, 191, 450. 
Zincl valeras, 434. 
Zingiber, 1,54. 



MAR 12 1908 



